Apply on Employer Site

AmeriHealth Caritas · 1 month ago

Provider Network Operations Data Analyst

Detroit, MI

Full-time

Hybrid

Entry Level

1+ years exp

AmeriHealth Caritas is a healthcare organization focused on Medicaid, Medicare, and Exchange products. They are seeking a Provider Network Operations Data Analyst to maintain accurate provider data and foster relationships with contracted and non-contracted providers. The role involves resolving provider-related issues and ensuring compliance with policy and regulatory standards.

Health CareInformation Technology

H1B Sponsor Likely

Responsibilities

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

Collaborate with internal departments to manage medical costs and support strategic initiatives

Demonstrates working knowledge of Facets, particularly the provider database, and consistently communicates updates, such as additions, deletions, or corrections, to the provider maintenance department

Qualification

Provider relations experienceManaged care experienceData analysis skillsMicrosoft ExcelMicrosoft AccessCommunication skillsProblem-solving skills

Required

Bachelor's degree or equivalent work experience required

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)

Preferred

3 years of experience in managed care or health insurance preferred

Company

AmeriHealth Caritas

Glassdoor3.4

AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.

Founded in 1982

Philadelphia, Pennsylvania, USA

10001+ employees

http://www.amerihealthcaritas.com

H1B Sponsorship

AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (18)

2024 (17)

2023 (12)

2022 (14)

2021 (4)

2020 (11)