AmeriHealth Caritas

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.

Position Overview: The Sr. Provider Network Data Analyst is a key liaison between the health plan and contracted and non-contracted providers across all product lines, including Medicare, Medicaid, and Exchange. This role ensures accurate provider representation in all operational systems, leads data integrity initiatives, and supports provider engagement and issue resolution.

Key Responsibilities:

• Maintain and communicate a thorough understanding of plan policies, procedures, and regulatory updates to providers.
• Monitor and manage provider network adequacy in compliance with state contract mandates.
• Oversee provider data management processes, ensuring accuracy and timeliness across systems.
• Mentor and guide Provider Network Data Analysts; assist in onboarding and training new team members.
• Act as a subject matter expert on complex provider data issues and serve as a key resource for internal teams.
• Develop and analyze reports to provide actionable insights using internal and external data sources.
• Evaluate departmental performance against service level goals, including accuracy, timeliness, and volume metrics.
• Represent Provider Network Management on committees and meetings, and lead team meetings in the supervisor’s absence.
• Maintain a provider data change log to track requests and monitor turnaround times.
• Review and validate data intake forms for completeness and accuracy.
• Communicate effectively with internal and external stakeholders to ensure high-quality service delivery.
• Escalate issues that conflict with established business processes or contract terms.
• Demonstrate expertise in provider data and managed care reimbursement methodologies.
• Identify and recruit qualified providers in new and existing service areas, ensuring compliance with contract terms and financial standards.
• Manage provider contracts and support credentialing, re-credentialing, and member complaint investigations.
• Conduct and document site visits and submit findings within required timeframes.
• Identify and report compliance issues with the plan policies.
• Utilize Facets and other systems to maintain accurate provider records and coordinate updates with the Provider Maintenance Department.
• Collaborate with cross-functional teams to develop strategies for managing medical costs.
• Perform administrative duties and participate in special projects as assigned.
• Adhere to all plan policies and complete required training annually.

Education & Experience:

• A bachelor’s degree or equivalent work experience is 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).
• Ability to work independently and manage multiple priorities.
• Valid driver’s license and current car insurance required.

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 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.