• Job Description

  Req#: 25271

  Responsibilities:

  The Provider Network Analyst Senior is responsible for research and analysis related to provider network issues. The incumbent will support new business provider recruitment and contracting and/or conduct research and analysis related to provider claims issues.

  Key responsibilities:

  • Identifies systematic and procedural issues resulting in processing reports and initiating actions to produce reports.
  • Extract, manipulate and evaluate accuracy of provider data for new implementations.
  • Responsible for ensuring plan remain in compliance with provider contracts.
  • Gathers complex statistical data analysis to identify financial and non-financial impacts, process and system improvements.
  • Use provider contract maintenance software to create provider contract templates and create files associated with contract templates and other credentialing forms.
  • Assist and coordinates configuration and testing to generate new reports as required.

  Configuration Management Responsibilities include, but are not limited to:

  • Analyzes and interpret data to determine appropriate configuration changes using in depth expertise in data analysis and data mining.
  • State benefits/policies, provider contracts, business requirements and converting these terms to configuration parameters.
  • Accurately interprets, updates and maintains benefit plans, provider contracts, fee schedules and various system tables through for the purpose of triaging production issues and developing business requirements for new configuration.
  • Demonstrates previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary.
  • Works with fluctuating volumes of work and can prioritize work to meet deadlines and needs of user community.

  Education/Experience:

  • Bachelor’s Degree (i.e., Business) or an equivalent education and experience.
  • Facets configuration knowledge. Building queries using SQL, MS Access, or other technical analysis tools.
  • 1-2 years managed care or related experience.
  • Advanced experience with sophisticated databases with 3-5 years analytical experience in the Healthcare industry.
  • Superior analytical skills.
  • Proficiency with Microsoft Office Suite (Word, Excel, Power Point).
  • Full competence in report preparation, layout and design.
  • Ability to plan, organize and handle multiple tasks.
  • Superior knowledge of national code sets and edits used in the Healthcare Industry.
  • Possesses in-depth expertise in data analysis and data mining.
  • Ability to perform impact analysis and make timely recommendations for issue resolution.
  • Ability to assess department’s needs and opportunities for improvement.
  • Ability to manage multiple projects concurrently.
  • Excellent analytical, organizational and research skills.
  • Demonstrated interpersonal, oral and written communication skills.
  • In-depth proficiency with office software applications (e.g., Microsoft Office Suite of products) as well as Crystal Reports and BI-Query.
  • Proficient in query language and analysis.

  
  

  AmeriHealth Caritas Ohio
  5525 Parkcenter Circle, Suite 100
  Dublin, OH 43017
  
  
  

• About the company

  AmeriHealth Caritas is a different kind of health care company. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP — plus pharmacy benefit management, behavioral health, and administrative services.

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