taleo
Senior Provider Network Operations Analyst
AmeriHealth Caritas
Remote, USA
Full-time
Senior · 3+ years experience
Remote
Discovered 2 weeks ago
Microsoft ExcelFacets
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 ExcelFacets
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 and will require the associate to work during Central/Eastern Standard Time (CST/EST) hours.
Candidates must have access to reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload).
Associates in locations where required may be eligible for internet reimbursement based on applicable regulations.
Responsibilities
- Review, analyze, and validate provider reimbursement and claim configuration requests in alignment with regulatory and contractual requirements.
- Review/approve and audit Payment Integrity (PI) vendor and internal prospective and retrospective edits/projects/recoveries
- User Acceptance Testing (UAT)/Client Review & audit
- Analyze Facets claims edit configuration requests to include intake and review of requests, impact assessment, and submission to Enterprise Operations.
- Encounter error reconciliation, representation, oversight, and management, including identification and initiation of claim or provider changes necessary to mitigate/prevent future errors
- Manage and resolve state complaints and escalated provider issues
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