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Senior Provider Performance Analyst

AmeriHealth CaritasUnited States
Remote · USAMid-Senior Level
11 views0 applied

Skills

  • DATA ANALYSIS
  • REPORTING
  • CLAIMS PROCESSING
  • PROVIDER INCENTIVE MODELS
  • DATA ACCURACY
  • DATA INTEGRITY
  • ROOT CAUSE ANALYSIS
  • BUSINESS RULES
  • DATA DICTIONARIES
  • DATABASE STRUCTURES
  • TESTING PROCESSES
  • MANAGED CARE

About the role

Role Overview: The Senior Provider Performance Analyst is responsible for developing, maintaining, and administering provider incentive models.

Work Arrangement:

  • Remote - This role may be performed from any location within the United States.
  • Availability required during Eastern Standard Time (EST) hours
  • Reliable high‑speed internet required (minimum 50 Mbps download / 5 Mbps upload)
  • Associates residing in states where reimbursement is required by contract, law, or regulation may submit eligible expenses for reimbursement

Responsibilities:

  • Develop, maintain, and execute provider incentive models across the enterprise.
  • Ensure the highest levels of data accuracy, integrity, consistency, and completeness across internal and external sources, including Oracle data warehouses.
  • Identify data-related issues and perform root cause analyses; collaborate with end-users and IT teams to resolve problems.
  • Define and maintain business rules governing the use and interpretation of reporting data fields.
  • Identify, validate, and manage data sources to support enterprise reporting needs.
  • Create, update, and maintain comprehensive documentation, including data dictionaries, business rules, database structures, and reporting procedures for all lines of business.
  • Develop and execute testing processes for data and reporting solutions; track and facilitate resolution of data-related issues.
  • Support training and education initiatives related to data comprehension, reporting, and provider performance tracking.
  • Assist in the design and refinement of models and metrics that measure provider performance.
  • Collaborate with associates across all organizational levels, as well as external clients and vendors.

Education & Experience:

  • Bachelor’s degree in a relevant field required.
  • 3 to 5 years of enterprise or business analytics experience in the managed care or healthcare industry preferred.
  • Minimum of 5 or more years of experience in data analysis, reporting, or claims processing required.

Skills & Abilities:

  • Strong written communication skills, including experience producing value‑based care collateral such as program descriptions, contracting documents, and proposals.
  • Demonstrated experience developing value-based programs and provider incentive models, including Episode of Care and Bundled Payment models.
  • Solid understanding of statutory reporting requirements.
  • Advanced proficiency in Microsoft Office Suite.
  • Proficiency in at least one reporting or data analysis tool (e.g., SAS Enterprise Guide, SQL, MS Access).
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