AmeriHealth Caritas is looking for a Provider Network Operations Data Analyst to maintain accurate provider data and foster strong relationships between the health plan and its contracted and non-contracted providers. You will ensure provider information is correctly represented in all operating systems and act as a proactive liaison to resolve provider-related issues efficiently.
What You'll Do
- 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 and reimbursement methodologies.
- Collaborate with internal departments to manage medical costs and support strategic initiatives.
What We're Looking For
- Bachelor’s degree or equivalent work experience.
- At least one year of experience working with healthcare providers and provider relations.
- Proficiency in Microsoft Excel & Access (formulas, pivot tables, charts/graphs).
- Strong analytical skills (non-IT focused).
Nice to Have
- 3 years of experience in managed care or health insurance.
Technical Stack
- Microsoft Excel
- Microsoft Access
- Facets (provider database)
Work Mode
This is a hybrid position based in the Detroit Metro area, Michigan.
