Remote Senior Provider Network Ops Analyst - Analytics

Search Results; Southfield (MI); On-site; USD 85,000 - 120,000; Full time

Job summary

Search Results is seeking a Senior Provider Network Operations Analyst to lead operational accuracy and regulatory compliance across provider data and claims configuration. You will audit edits, perform UAT reviews, and drive changes with EO/PNM to improve outcomes.

The role requires strong analytics, MS Office prowess, and healthcare claims experience. Remote work from Michigan with periodic meetings in Southfield, MI may apply.

Qualifications

• AAPC CPC/COC/CIC/CRC or NHA CBCS certification required.
• Associate's degree preferred or equivalent experience in healthcare.
• 3–5 years claims analysis experience in healthcare, managed care, or Medicaid preferred.
• Knowledge of claims payment configuration processes/systems and impact on operations.
• Strong MS Office (Excel, Access, Word) and data analytics skills.

Responsibilities

• Review/audit Payment Integrity vendor and internal edits/projects.
• Perform UAT/client reviews of provider data and Appian AGID configuration.
• Configure Facets claims edits: intake, review, impact assessment, initial submission.
• Reconcile encounter errors and identify provider changes to prevent future errors.
• Manage state complaints and analyze state policy/contract changes.
• Coordinate with BPO/workflow tools and provider network management.

Skills

Analytical skills

Organizational skills

Critical thinking

Customer service

Data analysis

Communication

Education

AAPC/NHA certification

Associate's degree preferred

Tools

Microsoft Excel

Microsoft Access

Pivot charts

Data analytics tools

Job description

Search Results is seeking a Senior Provider Network Operations Analyst to lead operational accuracy and regulatory compliance across provider data and claims configuration. You will audit edits, perform UAT reviews, and drive changes with EO/PNM to improve outcomes.

The role requires strong analytics, MS Office prowess, and healthcare claims experience. Remote work from Michigan with periodic meetings in Southfield, MI may apply.