AmeriHealth Caritas Configuration Auditor Analyst in Philadelphia, Pennsylvania

Configuration Auditor Analyst


Description

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:

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 that request is completed as intended.

Document all issues identified in the audit process and communicate audit outcome to the appropriate persons. The auditor will validate production to ensure that the case migrated appropriately. After changes migrate into production a full post implementation review is completed as outlined in the policy. 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. Auditor must possess a comprehensive knowledge of claims processing, both technical and workflow process components.

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:

  • 1 to 3 years' advanced level claims and auditing experience.
  • 3 to 5 years' system configuration and Microsoft Access.
  • Bachelor’s Degree.
  • Facets claim processing knowledge required.
  • Microsoft Access or equivalent relational database application experience.
  • Ability to build complex queries, reports, and macros.