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Provider Network Data Oversight Analyst Network Pricing - REMOTE

Company: AmeriHealth Caritas Health Plan
Location: Newtown Square
Posted on: June 25, 2022

Job Description:

Responsibilities:The Provider Network Data Oversight Analyst Network Pricing performs the role of data source expert to support AmeriHealth Caritas nationwide across all products and is responsible for oversight and validation of data from downstream processes/departments, assuring accuracy and validity while crystallizing results in recommendations; independently manages 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 issues, and general configuration. Collaborates with Actuarial, Network, and Operational areas to develop reports that provide event triggered output for monitoring of impending contract changes and provider patternsAnalyzes data to prepare summary level reports identifying new or unusual trends and anomalies in performance, and/or processes and supports findings and recommendations with valid data.Facilitates work sessions with Vendors, IT, Payment Systems, Operations Services, Provider Network Management, and Medical Affairs teams as needed to research issues including provider claim appeals as well as performing root cause analysis to resolve issues affecting provider reimbursement.Manages issue-tracking database to ensure that issues 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 benefit interpretation, claim payment policy, fee schedule development, provider contract interpretation and system interfaces/integration.Education/ Experience: Bachelor's Degree required.4 Years Analytics ExperienceAdvanced Microsoft Excel experience required.Experience with SQL and BI Tools such as Power BI or Tableau preferredSuperior 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 SAS, Access, Python, R, and Visual BasicDemonstrated 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.

Keywords: AmeriHealth Caritas Health Plan, Philadelphia , Provider Network Data Oversight Analyst Network Pricing - REMOTE, Professions , Newtown Square, Pennsylvania

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