AmeriHealth Caritas Provider Network Analyst in Philadelphia, Pennsylvania

Provider Network Analyst

Location: Philadelphia, PA

Telecommuter?: No

ID**: 14186

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us atwww.amerihealthcaritas.com.

Responsibilities:

Responsible for facilitating or performing root cause analysis and/or the development of reports, studies and data models related to monitoring the accuracy of benefit interpretation, claim payment, provider contract configuration, eligibility processing and revenue generating interfaces for CHC line of business. Defines and/or implements data modeling tools or reports designed to routinely assess existing operations processes including but not limited to benefit interpretation, claim payment accuracy systems interfaces and integration.

Education/Experience:

  • Bachelors degree or equivalent experience with emphasis in health services administration, information systems, or equivalent experience in medical office administration and/or claims administration, LTSS claims experience preferred

  • Three to five years claims experience

  • Report writing, data analysis, data research in managed care operations. LTSS claims experience a plus

  • Proficiency with Microsoft Office Suite (Word, Excel, Power Point). Access is a plus.

  • Consistent word processing speed and accuracy of 50 or more words per minute.

EOE Minorities/Females/Protected Veterans/Disabled