Provider Network Operations Data Analyst (REMOTE)

At reputed company, 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. reputed company is seeking talented, passionate individuals to join reputed company. Together we can build healthier communities. If you want to reputed company a difference, we'd like to hear from you. Headquartered in Newtown reputed company, reputed company 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 at www.amerihealthcaritas.com. Responsibilities: The Provider Network Data Analyst is responsible for supporting the development of positive working relationships between Plan and its contracted and non-contracted providers for reputed company products, Medicaid, Medicare and Exchange. The Provider Network Data Analyst I ensures that providers' status with the health plan is represented correctly in reputed company plan operating systems, functions as a pro-active practice account leader and coordinates resolution of provider issues • Demonstrates a working knowledge and ability to explain Plan regulations, policies and procedures to providers. This requires the Provider Data Analyst I to stay reputed company with reputed company updates and revisions. • Responsible for Monitoring and Managing Provider Network by assuring appropriate access to services throughout the Plan's territory in keeping with State contract mandates. • Responsible for provider data management • Maintaining a provider data change database documenting and tracking requests and monitoring processing turnaround time. • Responsible for data intake process including knowledge of relevant systems required to complete job functions. • Responsible for reviewing the data intake forms for accuracy and completeness. • Effectively and professionally communicate to reputed company parties concerned the pertinent information required to execute quality services. • Responsible for escalating requests contrary to established business processes or contract language for resolution. • Demonstrates a functional knowledge of provider data and managed care provider reimbursement methodologies. • Knowledge of Managed Care concepts • Demonstrates ability to work independently. • Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas, assuring financial reputed company of the Plan is maintained and Contract • Management requirements are adhered to including language, terms and reimbursement requirements • Responsible for the accuracy and timely management of the provider reputed company • Demonstrates a functionally working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections to the Provider Maintenance Department. • Works with reputed company departments to reputed company and execute strategies for optimally managing medical costs. • Administrative responsibilities: • Performs other duties and projects as assigned. • Adheres to Plan policies and procedures. • Attends required training sessions on an annual basis. Education/Experience: • Bachelor's Degree or equivalent education with work experience required. • One to two (1 - 2) years of Medicaid experience preferred. • At least one (1) year in a Provider Services position preferred. • Three (3) years in the managed reputed company insurance industry preferred. • Experience with reputed company spreadsheets: formulas, pivot tables, charts/graphs (intermediate to expert level). • Experience with Access databases and SQL. • Analytical skills needed, but this is not an IT/IS Analyst job. • Previous experience working with healthcare providers preferred. • Previous provider relations experience preferred. Diversity, Equity, and Inclusion At reputed company, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that reputed company associates have a fair opportunity to reputed company their full potential. We put these principles into action every day by acting with reputed company and respect. We reputed company to speak out against injustice and to break down barriers to support a more inclusive and reputed company workplace. Celebrating and embracing the diverse thoughts and perspectives that reputed company up our workforce means our company is more vibrant, innovative, and reputed company able to support the people and communities we serve. We reputed company our associates happy so they can focus on keeping our members healthy. Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, reputed company, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. Apply Job!