Provider Network Data Analyst - Healthcare (Contracting / Network Pricing)

AmeriHealth Caritas; Raleigh (NC); Hybrid; USD 70,000 - 90,000; Full time

Job summary

A leading health care organization seeks a Provider Network Data Oversight Analyst to ensure accurate payment terms data and analyze provider information for nationwide operations. The role involves managing multiple projects within a collaborative environment, using advanced analytics skills and knowledge of various data sources. Candidates should possess a Bachelor's degree, strong Excel proficiency, and experience with SQL and BI tools to enhance the company's operational performance. Comprehensive benefits offered including flexible work options, competitive pay, and health insurance from Day 1.

Benefits

Flexible work options (remote, hybrid)

Competitive pay

Paid time off including holidays and volunteer events

Health insurance from Day 1

401(k)

Tuition reimbursement

Qualifications

• Bachelor’s Degree required.
• At least four years of analytics experience.
• Advanced Microsoft Excel skills required.
• Experience with SQL and BI tools like Power BI or Tableau.

Responsibilities

• Collaborate with teams to develop monitoring tools for contract changes.
• Manage issue-tracking databases for timely resolutions.
• Develop data modeling tools or reports for provider network management.

Skills

Analytical Skills

Data Management

Communication

Excel

SQL

Education

Bachelor’s Degree

Tools

Power BI

Tableau

Databricks

SAS

Python

R

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.

Discover more about us at www.amerihealthcaritas.com.

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 providing recommendations. They independently manage multiple projects, including developing business logic for creating standard queries and reports. Under the direction of the Vice President – Network Pricing, they provide analytical support to the Provider Network Management team by analyzing provider data, payment term changes, and general configuration.

Responsibilities:

• Collaborate with Actuarial, Network, and Operational teams to develop monitoring tools for contract changes and provider patterns.
• Prioritize tasks effectively and communicate insights and recommendations clearly.
• Partner with Vendors, IT, Payment Systems, Operations Services, Provider Network Management, Market, and Clinical teams to research financial issues, risks, and opportunities related to fee schedules, chargemasters, contract terms, and outliers.
• Manage issue-tracking databases to ensure timely resolution of challenges, escalating issues as needed.
• Develop and implement data modeling tools or reports to support provider network management, contract performance, and new initiatives.

Education / Experience:

• Bachelor’s Degree required.
• At least four (4) years of analytics experience.
• Advanced Microsoft Excel skills required.
• Experience with SQL and BI tools such as Power BI or Tableau required.
• Strong analytical skills with large data sets, ability to identify anomalies, and recommend resolutions.
• Experience working with data from multiple sources.
• Additional experience with Databricks, SAS, Python, and R is relevant.
• Ability to communicate effectively with internal and external stakeholders.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone is valued, supported, and encouraged to be themselves. We are committed to equity and fairness, acting with integrity and respect daily. We stand against injustice and aim to create an inclusive, equitable workplace that embraces diverse perspectives, making our company more vibrant and innovative.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Includes flexible work options (remote, hybrid), competitive pay, paid time off including holidays and volunteer events, health insurance from Day 1, 401(k), tuition reimbursement, and more.