Prov Net Ops Data Analyst Sr

Amerihealth Caritas•,

4d•Remote

About The Position

The Senior Provider Network Operations Senior Data Analyst serves as a subject matter expert and key support resource within Provider Network Operations. This role is responsible for training new hires, keeping the team informed and prepared as process or system changes occur, supporting analysts with complex questions, and ensuring accurate, compliant, and timely processing of provider data, rosters, and provider files.

Requirements

Bachelor's degree or equivalent combination of education and relevant work experience.
3 to 5 years of experience in data analysis, healthcare operations, provider network operations, provider data operations, or a related field.
Experience with provider enrollment and changes.
Experience developing reports and analyzing complex datasets.
Proficiency in Microsoft Office Suite, particularly Excel, Word
Strong analytical and problem-solving skills with the ability to identify trends, root causes, and actionable insights.
Ability to prioritize and manage multiple competing priorities and projects simultaneously in a fast-paced environment.
Strong attention to detail and commitment to data accuracy.
Excellent organizational and communication skills.
Patience and professionalism when training new hires, coaching analysts, and supporting team members through process or system changes.
Flexible, adaptable, and willing to adjust to changing business needs, priorities, and deadlines.
Strong team player with a collaborative approach and willingness to support others to meet team and department goals.
Ability to work independently while effectively collaborating with cross-functional teams.

Nice To Haves

Managed care or healthcare experience preferred
Knowledge of Facets or similar healthcare administration platforms.
Experience supporting regulatory reporting and compliance initiatives preferred.

Responsibilities

Serve as a go-to subject matter expert for Provider Network Operations processes, including incoming provider data, provider enrollment file completion, and Facets updates.
Train new hires and provide ongoing education to analysts to ensure the team remains knowledgeable, consistent, and prepared as business requirements, systems, reporting needs, or processes change.
Process and oversee complex provider data files, large rosters, provider enrollments, and related updates while ensuring information is entered accurately and maintained appropriately in Facets and other applicable systems.
Monitor analyst workloads, review processing quality, audit analyst work, identify coaching opportunities, and provide guidance to support accuracy, productivity, and adherence to established procedures.
Develop new ideas and recommend process improvements that strengthen data quality, streamline enrollment and roster workflows, and improve team effectiveness.
Ensure provider data is accurate, complete, and compliant with internal standards, business rules, and reporting requirements; research and resolve discrepancies in a timely and thorough manner.
Maintain strong working relationships with provider groups, internal business partners, and cross-functional teams to support provider enrollment, data integrity, issue resolution, and operational needs.
User Acceptance Testing (UAT)/Client Review & audit (fee schedule concentration), reviews requests prior to initial submission to EO, and claims post-production
Capitation reconciliations, building queries, and comparing membership
Internal business report development; engagement with regulatory reporting
BAM/claim reporting submission and analysis, depending on complexity
Perform additional duties and special projects as assigned.