Config Auditor/Analyst

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

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:

• High School Diploma/GED required
• 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

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.