Vacancy expired!
Your career starts now. We're looking for the next generation of health care leaders. At AmeriHealth Caritas, we're 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'd like to hear from you. Headquartered in Philadelphia, 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.
Responsibilities: Under the direction of the Director, Health Services Reports & Controls this position is primarily responsible to support Health Services (HS) in the creation, maintenance, and data integrity of the operational report suite. Responsible for coordinating efforts to ensure that HS new business operational reports are developed and produced timely and accurately. • Acts as the primary point-of-contact for Health Services (HS) standard new business monitoring and trending reports; including, data element or algorithm modifications to align with State specific requirements. • Ensures HS operational production reports for new business are established (including coding criteria) and deployed in alignment with Health Plan go-live - including creation of a pre-work process. • Translates contractual service level requirements to functional specifications and/or engages the appropriate subject matter experts to ensure internal management reports comply with state reporting instructions. • Serves as the ongoing liaison between the functional areas and technical reporting teams to ensure appropriate translation of business acumen to technical specifications, and troubleshoot issues. • Monitors and audits operational reports to ensure accuracy and integrity of data - proactively communicates identified issues up and across. • Interprets complex problems/projects where analysis of situations or data requires an in-depth evaluation of multiple factors. • Demonstrates strong problem solving capabilities and approaches each problem in a logical and analytical manner with a high degree of resolve. • Collaborates with internal and external business areas to maintain a current working knowledge of: contractual, regulatory, internal, and informational metrics/requirements/service levels. • Active participant in cross-functional projects/workgroups to assess impacts to HS reporting including: new report development, data/rule changes, parameter/assumption modifications, and process amendments. • Communicate with stakeholders to determine appropriate course of action prior to enacting changes in reporting processes. • Completes special projects, adhoc & priority reporting, and other duties as assigned. • Adept at managing multiple priorities under time constraints. Education/ Experience:- Bachelor's Degree or equivalent work experience required.
- 3 to 5 years Healthcare/Managed care experience specifically in claims analysis and operations.
Vacancy expired!