Provider Network Operations Data Analyst
AmeriHealth Caritas
Southfield, MI
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JOB DETAILS
LOCATION
Southfield, MI
POSTED
16 days ago
Work Arrangement:
+ Remote – The associate can work remotely from anywhere in the Detroit Metro area, Michigan, and must be able to attend two weeks of in-office training at our Southfield, Michigan, location.
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.
+ Demonstrate working knowledge of provider databases (e.g., Facets) and reimbursement methodologies.
+ 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.
Education & Experience:
+ Bachelor’s degree or equivalent work experience required.
+ At least one year of experience working with healthcare providers and provider relations
+ 3 years of experience in managed care or health insurance preferred.
+ Proficiency in Microsoft Excel & Access (formulas, pivot tables, charts/graphs).
+ Strong analytical skills (non-IT focused)
As a company, we support internal diversity through:
Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.
About the Company
A
AmeriHealth Caritas
Leaders in health care solutions for those most in need
AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than 5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing innovative solutions that help improve health outcomes while reducing costs.
Our mission, our goal
Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.
COMPANY SIZE
5,000 to 9,999 employeesINDUSTRY
Healthcare Services
FOUNDED
1985
WEBSITE
http://www.amerihealthcaritas.com