taleo
Senior Provider Network Operations Analyst
AmeriHealth Caritas
Remote, USA
Full-time
Senior · 3+ years experience
Remote
Discovered 1 weeks ago
Microsoft ExcelAppianFacetspivot chartsAccess databases
Free
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Role Overview
The Senior Provider Network Operations Analyst serves as a subject matter expert within Provider Network Operations and is responsible for operational accuracy, regulatory compliance, claims configuration, provider data, and related network operations.
Key Skills for This Role
Microsoft ExcelAppianFacetspivot chartsAccess databases
Full Job Posting
Role Overview
The Senior Provider Network Operations Analyst serves as a subject matter expert within Provider Network Operations and is responsible for operational accuracy, regulatory compliance, claims configuration, provider data, and related network operations.
Work Arrangement
Remote - This position is fully remote; the associate must be located in Michigan (MI and attend monthly meetings as needed in Southfield, MI.
Requires reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload)
Internet reimbursement may be available where required by law or contract
Responsibilities
- Review/approve and audit Payment Integrity (PI) vendor and internal prospective and retrospective edits/projects/recoveries.
- User Acceptance Testing (UAT)/Client Review & audit (provider data, Appian Advanced Group ID (AGID) configuration, and set-up concentration) reviews requests prior to initial submission to Enterprise Operations (EO) and claims post-production.
- Facets claims edit configuration concentration (Appian) – intake, review, impact assessment, and initial submission; UAT reviews requests prior to initial submission to EO and claims post-production.
- Encounter error reconciliation representation, oversight, and management – including identification and initiation of claim or provider changes necessary to mitigate/prevent future errors.
- Management and resolution of state complaints.
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