• Job Description

  Req#: 39245
  Your career starts now. We're looking for the next generation of health care leaders.
  
  At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.
  
  Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
  
  Discover more about us at www.amerihealthcaritas.com.
  
  Responsibilities:
  
  Ability to use data analysis tools, including MS Access and Excel, along with a comprehensive understanding of claim payment rules and a thorough understanding of provider contracts, to analyze the effect configuration changes have on previously processed claims. Identify claims that need to be reworked to meet current contractual needs and perform other data analysis, as well as customer interactions, ensuring appropriate timelines are met. This associate must conduct claim analysis related to configuration changes on retroactive contracts and complete ad-hoc requests for both internal and external departments. This associate maintains responsibility for communicating the results of analysis, completing required forms, and forwarding them to appropriate departments for the reprocessing of claims. Through analysis, this associate identifies claim payment discrepancies and notifies the appropriate department for resolution. This associate is required to document all payment discrepancies identified through claims analysis and post implementation review process, and log and track the results of all analyses. This position requires the ability to work independently and prioritize accordingly, ensuring all turnaround goals are met. This associate maintains the highest degree of accuracy in all research and analysis and attends required training on an ongoing basis.
  
  Education & Experience:
  
  • Minimum of 1 year of MS Access and Excel experience.
  • Minimum of 3 years of Claims Processing and payment evaluation experience.
  • Strong analytical and critical thinking skills.
  • Associate's Degree or Bachelor's Degree preferred.
  • Previous experience with Facets claims system is highly preferred.
  
  Diversity, Equity, and Inclusion
  
  At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
  
  We keep our associates happy so they can focus on keeping our members healthy.
  
  Our Comprehensive Benefits Package
  
  Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

• About the company

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