Provider Network Operations Data Analyst

AmeriHealth Caritas

Southfield, MI, United States

3 months ago

Role details

Contract type

Permanent contract

Employment type

Full-time (> 32 hours)

Experience required

1 year minimum

Working hours

Regular working hours

Job source

Microsoft Access Microsoft Excel Databases Pivot Tables Computer Network Operations

Remote - The associate can work remotely from anywhere in the Detroit Metro area, Michigan, and must be able to attend two weeks of in-office training at our Southfield, Michigan, location., * Serve as a primary point of contact for providers, ensuring timely resolution of inquiries and issues.
Communicate plan policies, procedures, and regulatory updates clearly and professionally.
Maintain and monitor provider data to ensure accuracy across all systems.
Review and process provider data intake forms for completeness.
Track and document provider data changes to ensure timely updates and compliance with turnaround standards.
Escalate discrepancies or requests that conflict with business processes or contract terms.
Ensure timely and accurate management of provider contracts, including terms and reimbursement details.
Investigate and respond to member complaints within established timelines.
Identify and report compliance issues in accordance with plan policies and procedures.
Demonstrate working knowledge of provider databases (e.g., Facets) and reimbursement methodologies.
Collaborate with internal departments to manage medical costs and support strategic initiatives.
Demonstrates working knowledge of Facets, particularly the provider database, and consistently communicates updates, such as additions, deletions, or corrections, to the provider maintenance department.

Bachelor’s degree or equivalent work experience required.
At least one year of experience working with healthcare providers and provider relations
3 years of experience in managed care or health insurance preferred.
Proficiency in Microsoft Excel & Access (formulas, pivot tables, charts/graphs).
Strong analytical skills (non-IT focused)