Provider Network Analyst Senior

Company: AmeriHealth Caritas Health Plan
Location: Columbus
Posted on: January 27, 2023

Job Description:

Responsibilities:The Provider Network Analyst Senior is responsible for research and analysis related to provider network issues.The incumbent will support new business provider recruitment and contracting and/or conduct research and analysis related to provider claims issues.Key responsibilities:Identifies systematic and procedural issues resulting in processing reports and initiating actions to produce reports.Extract, manipulate and evaluate accuracy of provider data for new implementations.Responsible for ensuring plan remain in compliance with provider contracts.Gathers complex statistical data analysis to identify financial and non-financial impacts, process and system improvements.Use provider contract maintenance software to create provider contract templates and create files associated with contract templates and other credentialing forms.Assist and coordinates configuration and testing to generate new reports as required.Configuration Management Responsibilities include, but are not limited to:Analyzes and interpret data to determine appropriate configuration changes using in depth expertise in data analysis and data mining.State benefits/policies, provider contracts, business requirements and converting these terms to configuration parameters.Accurately interprets, updates and maintains benefit plans, provider contracts, fee schedules and various system tables through for the purpose of triaging production issues and developing business requirements for new configuration.Demonstrates previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary.Works with fluctuating volumes of work and can prioritize work to meet deadlines and needs of user community.Education/Experience:Bachelor's Degree (i.e., Business) or an equivalent education and experience.Facets configuration knowledge. Building queries using SQL, MS Access, or other technical analysis tools.1-2 years managed care or related experience.Advanced experience with sophisticated databases with 3-5 years analytical experience in the Healthcare industry.Superior analytical skills.Proficiency with Microsoft Office Suite (Word, Excel, Power Point).Full competence in report preparation, layout and design.Ability to plan, organize and handle multiple tasks.Superior knowledge of national code sets and edits used in the Healthcare Industry.Possesses in-depth expertise in data analysis and data mining. Ability to perform impact analysis and make timely recommendations for issue resolution. Ability to assess department's needs and opportunities for improvement.Ability to manage multiple projects concurrently. Excellent analytical, organizational and research skills.Demonstrated interpersonal, oral and written communication skills.In-depth proficiency with office software applications (e.g., Microsoft Office Suite of products) as well as Crystal Reports and BI-Query.Proficient in query language and analysis.

Keywords: AmeriHealth Caritas Health Plan, Columbus , Provider Network Analyst Senior, Professions , Columbus, Ohio