Provider Network Operations Analyst
A
AmeriHealth Caritas
📍 United States, United States, United States
Job Description
**Job Summary:**
This position reports to the Manager, Provider Reimbursement and is responsible for facilitating and investigating cross-departmental issue resolution as it relates to provider claim reimbursement. The primary purpose of this role is to maintain current provider data and provider reimbursement setup, and to address provider and state inquiries related to claim payment issues.
**Responsibilities:**
+ Develop pricing and agreements for provider reimbursement setup.
+ Ensure that provider payment issues submitted by Provider Network Management or any other source are validated, researched, and resolved within established SLA timeframes.
+ Serve as the subject matter expert in state-specific health reimbursement rules and provider billing requirements, and act as a liaison to the Enterprise Operations Configuration Department.
+ Maintain a current working knowledge of processing rules, contractual guidelines, state/Plan policies, and ope...
This position reports to the Manager, Provider Reimbursement and is responsible for facilitating and investigating cross-departmental issue resolution as it relates to provider claim reimbursement. The primary purpose of this role is to maintain current provider data and provider reimbursement setup, and to address provider and state inquiries related to claim payment issues.
**Responsibilities:**
+ Develop pricing and agreements for provider reimbursement setup.
+ Ensure that provider payment issues submitted by Provider Network Management or any other source are validated, researched, and resolved within established SLA timeframes.
+ Serve as the subject matter expert in state-specific health reimbursement rules and provider billing requirements, and act as a liaison to the Enterprise Operations Configuration Department.
+ Maintain a current working knowledge of processing rules, contractual guidelines, state/Plan policies, and ope...