Senior Provider Network Operations Analyst

AmeriHealth Caritas

📍 Manchester, New Hampshire, United States 💼 Full-time 🕒 Posted June 12, 2026

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Job Description

Responsibilities
 :Review/approves and audits Payment Integrity (PI) vendor and internal prospective and retrospective edits/projects/recoveries
User Acceptance Testing (UAT)/Client Review & audit (provider data, Appian Advanced Group ID (AGID) configuration, and set-up concentration) reviews requests prior to initial submission to Enterprise Operations (EO) and claims post-production
Facets claims edit configuration concentration (Appian) – intake, review, impact assessment, and initial submission; UAT reviews requests prior to initial submission to EO and claims post-production
Encounter error reconciliation representation, oversight and management – including identification and initiation of claim or provider changes necessary to mitigate/prevent future errors
Management and resolution of state complaints
State policy and contract amendment changes analysis and management
Internal or vendor medical policy or Health Value Opti...
            

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Job Details

Location Manchester, New Hampshire
Job Type Full-time
Category Computer Occupations
Posted Date June 12, 2026
Application Deadline July 22, 2026