Senior Provider Network Operations Data Analyst

AmeriHealth Caritas; Detroit (MI); Remote; USD 75,000 - 95,000; Full time

Job summary

Join AmeriHealth Caritas as a Senior Provider Network Data Analyst and play a pivotal role in enhancing provider data management. You will be responsible for ensuring data accuracy, mentoring junior analysts, and collaborating across departments to support our mission of delivering quality care. Bring your experience in managed care and data management to a leading organization dedicated to building healthier communities.

Benefits

Flexible work solutions

Competitive pay

Paid time off

Health insurance coverage from Day 1

401(k)

Tuition reimbursement

Qualifications

• 3 to 5 years of experience in Medicaid and provider data management preferred.
• 5 to 10 years of experience in managed care or the healthcare industry.
• Strong knowledge of managed care concepts and provider reimbursement methodologies.

Responsibilities

• Ensure provider data accuracy and compliance with state contract requirements.
• Mentor and support Provider Network Data Analysts.
• Analyze data to generate reports and insights for decision-making.

Skills

Data Management

Mentoring

Communication

Problem Solving

Education

Bachelor’s degree or equivalent work experience

High school diploma/GED

Tools

Microsoft Office

Provider Data Systems (e.g., Facets)

Job description

Role Overview:; At AmeriHealth Caritas, we believe data is more than just numbers—it’s the foundation of trust, access, and quality care. As a Senior Provider Network Data Analyst, you’ll be at the center of that mission, a vital connector between our health plan and the providers who care for our members across Medicare, Medicaid, and Exchange products.

In this role, you won’t just manage data—you’ll ensure that every provider is accurately represented in our systems, help resolve issues that impact provider satisfaction, and lead initiatives that improve data integrity and operational efficiency. You’ll also mentor team members, collaborate across departments, and play a key role in shaping a provider network that delivers on our promise of care with compassion.

Work Arrangement:

• This position is remote.
• There are required onsite meetings at 4000 Town Center, Suite 1300, Southfield, MI 48075.
• The candidate must live in the Detroit, Michigan area.;
• There are 2 weeks of onsite training in Southfield, MI.;

Responsibilities:

• Maintain and communicate up-to-date knowledge of plan policies, procedures, and regulatory changes to providers.
• Ensure provider network adequacy and compliance with state contract requirements.
• Oversee provider data accuracy and timeliness across systems, including managing data intake and change logs.
• Mentor and support Provider Network Data Analysts, onboarding and training new team members.
• Serve as a subject matter expert on complex provider data issues and support internal teams.
• Analyze internal and external data to generate reports and insights that guide decision-making.
• Monitor departmental performance against service level goals and lead meetings when needed.
• Support provider recruitment, contract management, credentialing, and complaint resolution.
• Conduct site visits, document findings, and ensure timely report submission.
• Collaborate across departments to manage medical costs, ensure compliance, and support special projects.

Education & Experience:

• A bachelor’s degree or equivalent work experience is preferred.
• High school diploma/GED required
• 3 to 5 years of experience in Medicaid and provider data management preferred.
• 5 to 10 years of experience in managed care or the healthcare industry.
• Prior experience working with healthcare providers; provider relations experience preferred.
• Strong knowledge of managed care concepts and provider reimbursement methodologies.
• Proficiency in Microsoft Office and provider data systems (e.g., Facets).

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Licensure:

• Must have a valid driver’s license and current car insurance.;

Skills & Abilities:

• Ability to manage multiple priorities, meet deadlines, and handle administrative tasks efficiently.
• Experience guiding junior analysts and supporting onboarding and development.
• Skilled in identifying issues, escalating appropriately, and implementing practical solutions.
• Strong written and verbal communication skills for interacting with providers and internal teams.

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Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are 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 would like to connect with you.

Headquartered in Newtown Square, PA, 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.

Our Comprehensive Benefits Package

Flexible work solutions include 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.

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