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Provider Network Operations Analyst Jobs (NOW HIRING)

Koniag, Inc.

Network Operations Analyst

Washington, DC · On-site

$115K - $135K/yr

The Network Operations Analyst serves as a frontline operations specialist within CLIENT's enterprise Network Operations Center (NOC), providing continuous 24x7x365 monitoring, event detection ...

Amerihealth Caritas

Supv Prov Net Ops

Southfield, MI · Remote

$77K - $104K/yr

The Provider Network Operations Supervisor supports the daily operations of the Provider Network ... Analytical and problem-solving skills with attention to detail * Ability to manage multiple ...

kgs

Network Operations Analyst

Durham, NC

... Network Operations Analyst to support TGS and our government customer in Durham, NC or Baltimore ... Provide hardware and software engineering, technical support services, training for operation of ...

Megaport

Launched in 2019, Latitude.sh provides automated, global Bare Metal infrastructure with cloud-like ... We are looking for a Senior Network Operations Analyst to join our Network Team, capable of ...

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How much do provider network operations analyst jobs pay per hour?

As of Sep 10, 2026, the average hourly pay for provider network operations analyst in the United States is $35.28, according to ZipRecruiter salary data. Most workers in this role earn between $26.44 and $39.90 per hour, depending on experience, location, and employer.

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Infographic showing various Provider Network Operations Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $73,392 per year, or $35.3 per hour.

Senior Provider Network Operations Analyst

Southfield, MI • Remote

Amerihealth Caritas
Health Care and Social Assistance • 5 - 10K employees
Learn more about Amerihealth Caritasexternal

Full-time

Posted 7 days ago

AmeriHealth Caritas rating

8.3

Company rating: 8.3 out of 10

Based on 73 frontline employees who took The Breakroom Quiz

133rd of 315 rated insurance

Job description

Role Overview: The Senior Provider Network Operations Analyst serves as a subject matter expert within Provider Network Operations and is responsible for operational accuracy, regulatory compliance, claims configuration, provider data, and related network operations.

Work Arrangement:

  • Remote - This position is fully remote; the associate must be located in Michigan (MI) and attend monthly meetings as needed in Southfield, MI.
  • Requires reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload)
  • Internet reimbursement may be available where required by law or contract

Responsibilities:

  • Review/approve and audit 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 Optimization (HVO) edit changes and initiatives.
  • Monitor and review state communications and changes, lead initial analysis/determination of action, provide direction on work request submissions to level I analysts, and test/audit subsequent changes.
  • Business Process Outsourcing (BPO) and/or other intake/workflow tool management.
  • Single-case agreement management/ownership, including letter development and coordination with Provider Network Management (PNM).
  • Serves as the subject matter expert in state-specific health reimbursement rules and provider billing requirements and as liaison to the Enterprise Operations Configuration Department.
  • Maintain a current working knowledge of processing rules, contractual guidelines, state/Plan policy, and operational procedures to effectively provide technical expertise and business rules.
  • Acts as the resource to other departments by developing and managing work plans which document the status of key relationship issues and action items for high-profile providers.
  • Performs other related duties and projects as assigned

Education & Experience:

  • American Academy of Professional Coders (AAPC) certification (CPC, COC, CIC, CRC) or NHA (CBCS) certification required.
  • Associate’s degree preferred, or equivalent combination of education and experience in a healthcare field.
  • 3 to 5 years of claims analysis experience in healthcare, managed care, or Medicaid environment preferred.
  • Claims processing and Provider data maintenance knowledge required
  • Understanding of and experience related to healthcare claims payment configuration process/systems and its relevance/impact on network operations required
  • Strong working knowledge of Microsoft Excel, Access, Word, and other MS Office tools; ability to work with pivot charts, Access databases, and data analytics.

Skills & Abilities:

  • Ability to focus on technology and business issues, as well as communicate appropriately with both technology and business experts
  • Strong analytic problem-solving skills
  • Superior organizational skills required
  • Critical thinking skills
  • Strong customer service skills
  • Data and reporting analysis

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