Note: The job is a remote job and is open to candidates in USA. AmeriHealth Caritas is seeking a Senior Provider Network Operations Data Analyst to serve as a subject matter expert and key support resource within Provider Network Operations. The role supports provider data processing, enrollment and roster workflows, analyst training and quality oversight, reporting, reconciliations, compliance, and process improvement.
Responsibilities
- Serve as a go-to subject matter expert for Provider Network Operations processes, including incoming provider data, provider enrollment file completion, and Facets updates
- Train new hires and provide ongoing education to analysts to ensure the team remains knowledgeable, consistent, and prepared as business requirements, systems, reporting needs, or processes change
- Process and oversee complex provider data files, large rosters, provider enrollments, and related updates while ensuring information is entered accurately and maintained appropriately in Facets and other applicable systems
- Monitor analyst workloads, review processing quality, audit analyst work, identify coaching opportunities, and provide guidance to support accuracy, productivity, and adherence to established procedures
- Develop new ideas and recommend process improvements that strengthen data quality, streamline enrollment and roster workflows, and improve team effectiveness
- Ensure provider data is accurate, complete, and compliant with internal standards, business rules, and reporting requirements; research and resolve discrepancies in a timely and thorough manner
- Maintain strong working relationships with provider groups, internal business partners, and cross-functional teams to support provider enrollment, data integrity, issue resolution, and operational needs
- User Acceptance Testing (UAT)/Client Review & audit (fee schedule concentration), reviews requests prior to initial submission to EO, and claims post-production
- Capitation reconciliations, building queries, and comparing membership
- Internal business report development; engagement with regulatory reporting
- BAM/claim reporting submission and analysis, depending on complexity
- Perform additional duties and special projects as assigned
Skills
- Candidates residing in Michigan
- Occasional travel for meetings, training, or business needs may be required
- Bachelor's degree or equivalent combination of education and relevant work experience
- 3 to 5 years of experience in data analysis, healthcare operations, provider network operations, provider data operations, or a related field
- Experience with provider enrollment and changes
- Experience developing reports and analyzing complex datasets
- Knowledge of Facets or similar healthcare administration platforms
- Strong analytical and problem-solving skills with the ability to identify trends, root causes, and actionable insights
- Proficiency in Microsoft Office Suite, particularly Excel, Word
- Ability to prioritize and manage multiple competing priorities and projects simultaneously in a fast-paced environment
- Strong attention to detail and commitment to data accuracy
- Excellent organizational and communication skills
- Patience and professionalism when training new hires, coaching analysts, and supporting team members through process or system changes
- Flexible, adaptable, and willing to adjust to changing business needs, priorities, and deadlines
- Strong team player with a collaborative approach and willingness to support others to meet team and department goals
- Ability to work independently while effectively collaborating with cross-functional teams
- Managed care or healthcare experience preferred
- Experience supporting regulatory reporting and compliance initiatives preferred
Benefits
- Fully remote position for candidates residing in Michigan
Company Overview
Company H1B Sponsorship