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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, 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 direct supervision of the Provider Enrollment Supervisor, the Provider Enrollment Specialist is responsible for maintaining both participating and non-participating provider records in the provider database, mapping claims in the invalid provider queue, resolving provider-related issues for claims suspended to Provider Enrollment. Executes the panel transfer process. Completes projects as assigned by Supervisor. Interacts with internal/external clients on provider maintenance activities.
• Communicates notification of changes to appropriate providers, members, and other departments within the contracted time frame.
• Coordinates the provider mailing for all claims in the invalid provider queue that could not be processed due to missing or invalid information.
• Researches and resolves returned checks and provider mail.
• Assists provider and internal customer by responding to and resolving all requests and inquiries related to the Panel Transfers, Panel Releases, & Special Needs PCP assignments process.
• Completes department reports and logs as assigned.
• Ensures that work is completed according to service level agreements.
• Attends required training on an annual basis.
Education/Experience:
• Associate’s Degree or equivalent work experience.
• Minimum 1-year related work experience in healthcare.
• Claims experience, preferred.
• Knowledge of different types of providers and claims process experience is preferred. ;;
• Software systems including MS Office (Word, Excel, Access, and Outlook).;
• Facets experience, preferred.;
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 including 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.
