Senior Provider Network Operations Data Analyst

Title: Senior Provider Network Operations Data Analyst

LocationDetroit, MI

Primary Job FunctionProvider Network

ID**41426

Job Description:

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.

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:

• Remote - Associate can work remotely within Detroit, Michigan.
• Onsite - Attend onsite meetings at 4000 Town Center, Suite 1300, Southfield, MI 48075.
• Must live in the Detroit, Michigan area.
• Must have a valid driver's license and current car insurance.
• Training: 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).

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.

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.