Senior Provider Network Operations Analyst (Remote)

RPMGlobal; Northern (KY); Hybrid; USD 90,000 - 120,000; Full time

Job summary

RPMGlobal is seeking a Senior Provider Network Operations Analyst to join our remote team in the United States. The role focuses on operational accuracy, regulatory compliance, claims configuration, and provider data within Provider Network Operations.

The candidate will review reimbursement configurations, audit PI edits, and manage state-specific provider issues while coordinating changes with the Enterprise Operations Configuration Department.

Qualifications

• 3–5 years of claims analysis experience in healthcare, managed care, or Medicaid environments preferred.
• Claims processing and provider data maintenance knowledge required.
• Understanding of healthcare claims payment configuration process/systems and its impact on network operations.

Responsibilities

• Review and validate provider reimbursement and claim configuration requests per regulatory and contractual requirements.
• Audit Payment Integrity (PI) vendor and internal edits/projects/recoveries.
• Analyze Facets claims edit configuration requests from intake to submission and impact assessment.
• Encounter error reconciliation and management, identifying changes to mitigate future errors.
• Manage state-level provider issues and escalations; monitor state communications and lead action determinations.
• Lead policy/contract changes analysis and coordinate with stakeholders
• Support internal and vendor reimbursement policies and identify cost containment opportunities.
• Manage single-case agreements and liaise with Provider Network Management
• Maintain knowledge of processing rules, contracts, state plans and operational procedures.

Skills

Tech-business communication

Education

AAPC CPC/COC/CIC/CRC certification

NHA CBCS certification

Associate’s degree

Tools

Microsoft Excel

Microsoft Access

Microsoft Word

Pivot charts

Job description

RPMGlobal is seeking a Senior Provider Network Operations Analyst to join our remote team in the United States. The role focuses on operational accuracy, regulatory compliance, claims configuration, and provider data within Provider Network Operations.

The candidate will review reimbursement configurations, audit PI edits, and manage state-specific provider issues while coordinating changes with the Enterprise Operations Configuration Department.