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 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:Audit and analyze all Facets configuration changes completed by the configuration analysts to ensure that all modifications have been completed correctly. Review all associated documentation for completeness. Communicate with the configuration analyst, configuration team lead, tester, and requestor as required to ensure the request is completed as intended. Document all issues identified in the audit process and communicate the audit outcome to the appropriate persons. The auditor will validate production to ensure that the case is migrated appropriately. After changes migrate into production, a full post-implementation review is completed as the policy outlines. The auditor will be expected to build/run complex queries to identify claims affected by the configuration change and analyze all claims to ensure that all outcomes are accurate based on the request. Auditors must possess a comprehensive knowledge of technical and workflow process components of claims processing.;All auditors must attend ongoing training as needed and meet all production and quality goals to assist the team in meeting all required Service Level Agreements.Education/Experience:
Bachelor’s Degree preferred
Minimum of 1 year of advanced-level claims experience and auditing experience
Minimum of 3 years of system configuration experience
Facets claim processing knowledge required
Microsoft Access or equivalent relational database application experience
Ability to build complex queries, reports, and macros
Diversity, Equity, and InclusionAt 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 PackageFlexible 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.;As a company, we support internal diversity through:Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.
