Provider Network Operations Analyst (Hybrid) - AmeriHealth Caritas
Manchester, NH
About the Job
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.
The Provider Network Operations Analyst is responsible for the following day to day activities in support of the New Hampshire Health Plan:;
+ Claims resolution: working with Enterprise Operations, providers and the Provider Network Management team;
+ Informal provider disputes including intakes, investigations, resolutions
+ Member grievances (related to billing) via the Contact Center/Enterprise Operations, 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.
Education/ Experience:;
+ High School Diploma/GED required. Associates Degree or equivalent combination of education and work experience in a Managed Care or Health Care setting preferred.
+ Minimum of 2 years proven claims practice in a managed care, health care or insurance industry environment (systems experience using Facets or EXP Macess, is a plus).
+ Must have Medicaid/Medicare Provider data experience updating the directory, claims payout, etc.
+ Experience with the appeals and grievance process preferred
+ Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint). ;MS Access experience is a plus and ability to accurately type 35 wpm or more.
+ Required ability to collaboratively or independently; deliver high quality work, demonstrate intellect, resourcefulness, curiosity, attention to detail, and strong communication skills.
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
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.
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.
The Provider Network Operations Analyst is responsible for the following day to day activities in support of the New Hampshire Health Plan:;
+ Claims resolution: working with Enterprise Operations, providers and the Provider Network Management team;
+ Informal provider disputes including intakes, investigations, resolutions
+ Member grievances (related to billing) via the Contact Center/Enterprise Operations, 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.
Education/ Experience:;
+ High School Diploma/GED required. Associates Degree or equivalent combination of education and work experience in a Managed Care or Health Care setting preferred.
+ Minimum of 2 years proven claims practice in a managed care, health care or insurance industry environment (systems experience using Facets or EXP Macess, is a plus).
+ Must have Medicaid/Medicare Provider data experience updating the directory, claims payout, etc.
+ Experience with the appeals and grievance process preferred
+ Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint). ;MS Access experience is a plus and ability to accurately type 35 wpm or more.
+ Required ability to collaboratively or independently; deliver high quality work, demonstrate intellect, resourcefulness, curiosity, attention to detail, and strong communication skills.
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
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.
Source : AmeriHealth Caritas