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Agent guide: [/agents.md](https://www.wearedevelopers.com/agents.md). --- # Senior Provider Network Operations Analyst - **Company:** AmeriHealth Caritas - **Location:** Southfield, MI, United States (Remote available) - **Experience:** Expert - **Salary:** $62,400.0 - **Contract:** Internship / Graduate position - **Skills:** Microsoft Access, Microsoft Word, Microsoft Excel, Databases, Microsoft Office, Network Administration, Pivot Charts, Computer Network Operations, Appian, Data Analytics - **Published:** September 4, 2026 - **Apply:** https://www.careerjet.com/job/usfafccc431cb4428b5eedaba9ef3ef1a1/eaa ## About the Role * American Academy of Professional Coders (AAPC) certification (CPC, COC, CIC, CRC) or NHA (CBCS) certification required. * Associate's degree preferred, or equivalent combination of education and experience in a healthcare field. * 3 to 5 years of claims analysis experience in healthcare, managed care, or Medicaid environment preferred. * 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 * Strong working knowledge of Microsoft Excel, Access, Word, and other MS Office tools; ability to work with pivot charts, Access databases, and data analytics. Skills & Abilities: * Ability to focus on technology and business issues, as well as communicate appropriately with both technology and business experts * Strong analytic problem-solving skills * Superior organizational skills required * Critical thinking skills * Strong customer service skills * Data and reporting analysis ## Description 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. * 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 ## Related Videos - [ZEISS & Microsoft - Building the Next Generation Medical Ecosystem in the Cloud](https://www.wearedevelopers.com/videos/424-zeiss-microsoft-building-the-next-generation-medical-ecosystem-in-the-cloud) - [WeAreDevelopers LIVE – From JavaScript to WebAssembly, High-Performance Charting and More](https://www.wearedevelopers.com/videos/1794-wearedevelopers-live-from-javascript-to-webassembly-high-performance-charting-and-more) - [Kubernetes and Microservices with Multi-Model Databases](https://www.wearedevelopers.com/videos/382-kubernetes-and-microservices-with-multi-model-databases) - [From Global Capability Centers to AI-Powered Command Centers](https://www.wearedevelopers.com/videos/100096-from-global-capability-centers-to-ai-powered-command-centers) - [Web development best practices in 2021](https://www.wearedevelopers.com/videos/280-web-development-best-practices-in-2021) - [Fault Tolerance and Consistency at Scale: Harnessing the Power of Distributed SQL Databases](https://www.wearedevelopers.com/videos/1146-fault-tolerance-and-consistency-at-scale-harnessing-the-power-of-distributed-sql-databases) ## Related Articles - [Data Analyst Salary in the UK](https://www.wearedevelopers.com/magazine/278-data-analyst-salary-in-the-uk) - [What Are The Top Skills Required For Azure Developers?](https://www.wearedevelopers.com/magazine/77-what-are-the-top-skills-required-for-azure-developers) - [Data Analyst Salary Germany](https://www.wearedevelopers.com/magazine/277-data-analyst-salary-germany) - [Best Paying Jobs in Technology](https://www.wearedevelopers.com/magazine/256-best-paying-jobs-in-technology) - [Software Developer Salary in The Netherlands [2023]](https://www.wearedevelopers.com/magazine/217-software-developer-salary-in-the-netherlands-2023) - [How to land a developer job in Amsterdam](https://www.wearedevelopers.com/magazine/36-how-to-land-a-developer-job-in-amsterdam)