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# Senior Provider Network Operations Analyst

- **Company:** AmeriHealth Caritas
- **Location:** Newtown Square, PA, United States (Remote available)
- **Experience:** Expert
- **Contract:** Permanent contract
- **Skills:** Microsoft Access, Microsoft Word, Microsoft Excel, Databases, Microsoft Office, Network Administration, Pivot Charts, Computer Network Operations, Appian, Data Analytics
- **Published:** August 9, 2026
- **Apply:** https://www.financialjobbank.com/job.asp?id=3347433486&tx=UT6056THI&pt=1&aff=0B19D771-A501-4A5E-8338-2A822B784D54&utm_source=Job%20Feed&utm_medium=textkernel&utm_campaign=DE&utm_term=0B19D771-A501-4A5E-8338-2A822B784D54

## About the Role

* Associate's degree preferred, or equivalent combination of education and experience in a healthcare field.
 * American Academy of Professional Coders (AAPC) certification (CPC, COC, CIC, CRC) or NHA (CBCS) certification required.
 * 3 to 5 years of claims analysis experience in healthcare, managed care, or Medicaid environment preferred.
 * Strong working knowledge of Microsoft Excel, Access, Word, and other MS Office tools; ability to work with pivot charts, Access databases, and data analytics.
 * Claims processing and Provider data maintenance knowledge required
 * Understanding of and experience related to healthcare claims payment configuration process/systems and its relevance/impact on network operations required

Skills & Abilities:

 * Ability to focus on technology and business issues, as well as communicate appropriately with both technology and business experts
 * Superior organizational skills required
 * Critical thinking skills
 * Strong customer service skills
 * Data and reporting analysis

## Description

* Review/approve and audits 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
 * State policy and contract amendment changes analysis and management
 * Internal or vendor medical policy or Health Value Optimization (HVO) edit changes and initiatives
 * Monitor and review state communications and changes, lead initial analysis/determination of action, provide direction on work request submissions to level I analysts, and test/audit subsequent changes
 * Business Process Outsourcing (BPO) and/or other intake/workflow tool management
 * Single-case agreement management/ownership, including letter development and coordination with Provider Network Management (PNM)
 * Serves as the subject matter expert in State specific health reimbursement rules and provider billing requirements and as liaison to the Enterprise Operations Configuration Department
 * Maintain a current working knowledge of processing rules, contractual guidelines, state/Plan policy and operational procedures to effectively provide technical expertise and business rules
 * Acts as the resource to other departments by developing and managing work plans which document the status of key relationship issues and action items for high profile providers
 * Performs other related duties and projects as assigned


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