Job Description

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. The Provider Network Data Oversight Analyst performs the role of payment terms data source expert to support AmeriHealth Caritas nationwide across all products. They are responsible for oversight and validation of information from multiple external and internal sources and departments, assuring accuracy and validity while crystallizing results in recommendations. They independently manage multiple projects including the development of the business logic for the subsequent creation of standard queries and reporting. Under the direction of the Vice President – Network Pricing, provides analytical support to the Provider Network Management team by performing analysis of provider data, payment term changes, and general configuration. Responsibilities: Collaborates with Actuarial, Network, and Operational areas to develop lenses that provide event triggered output for monitoring of impending contract changes and provider patterns. Effectively prioritizes and communicates insights and recommendations. Facilitates partnerships with Vendors, IT, Payment Systems, Operations Services, Provider Network Management, Market, and Clinical teams as needed to research financial issues, risks, and opportunities related to fee schedules, chargemasters, contract terms, and outliers. Manages issue-tracking database to ensure that challenges are resolved within established timeframes and escalates open issues as needed. Defines, develops, and/or implements data modeling tools or reports designed to routinely assess and support existing and new provider network management processes, programs, contract performance, and proposed initiatives, such as fee schedule development, provider contract interpretation’ and system interfaces/integration. Education / Experience: Bachelor’s Degree required. At least four (4) years of Analytics experience. Advanced Microsoft Excel experience required. Experience with SQL and BI Tools such as Power BI or Tableau required. Superior analytical skills including the use of very large data sets; ability to recognize anomalies in findings, and pursue and/or recommend resolution. Ability to work with integrated data from multiple sources. Other relevant experience includes work with Databricks, SAS, Python, and R. Demonstrated ability in effectively interfacing with key leaders and stakeholders both internal and external to the organization to research technical and/or operational issues and define solutions. Must have excellent communication skills. We keep our associates happy so they can focus on keeping our members healthy. 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. #J-18808-Ljbffr RPMGlobal

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