Provider Network Operations Analyst

The Provider Network Ops Analyst is responsible for: 

• Claims resolution: working with EO, providers and Provider Network Management
• Informal provider disputes– intake, investigation, resolution
• Member grievances (related to billing) via Contact Center/EO, Compliance, etc.
• Submission/audit of any necessary OLH updates to Knowledge Management
• Intake/workflow tool management
• DME/other manual pricing/invoice intake, development, ownership
• Participate in credit balance inquiries and investigations.

Work Arrangement: Remote based with a preference of North Carolina resident

Education/ Experience: 

• High School Diploma/GED required.
• Associate’s Degree or equivalent combination of education and work experience in a Health Care field preferred.
• Claims experience, as well as experience in healthcare, managed care or insurance industry environment.
• Provider data experience preferred.
• Proficiency with Microsoft Office Suite (Word, Excel, Power Point).  MS Access experience is a plus.  
• Sound personal management skills to plan, organize, schedule, and complete own work and work that is coordinated with others.
• Superior organizational skills required.
• Critical thinking skills.
• Detail oriented.
• Excellent written and verbal communication.

Other:

• Certified Professional Coding certification preferred.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, 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.

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 Newtown Square, 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 at www.amerihealthcaritas.com.