Analyst - Medicaid Network Operations

CVS Health•Work At Home-Illinois, IL

2d•$46,988 - $112,200•Onsite

About The Position

The Contract Coordinator Analyst plays a critical role in supporting the Medicaid Network management team throughout the provider contracting lifecycle for Aetna Better Health of Illinois. This position works hand in hand with the Network Contracting Manager to ensure the accuracy and integrity of provider contract documentation for new providers joining the network, maintaining up-to-date provider information within internal systems, and supports compliance with regulatory and organizational requirements.

Requirements

2-5 years of professional work experience, 1 year in the healthcare industry
Experience working in TriZetto QNXT
Experience with medical terminology
Experience working with Microsoft Office Suite
Proven ability to manage multiple workflows, prioritize effectively, and meet deadlines
Strong written and verbal communication skills, with the ability to convey complex information clearly

Nice To Haves

SQL Database Queries
Intermediate Microsoft Excel skills (Excel formulas and pivot tables)
Business reporting

Responsibilities

Perform thorough reviews of all incoming contractual documents to ensure completeness and accuracy; work with contracting staff to obtain missing or incomplete documents as needed
Work with national provider data service team to load newly contracted providers to the provider record database in a timely manner
Audit updated provider records to ensure the correct changes were made to the database; submit corrections as needed
Maintain the master repository of participating provider contracts, load newly executed provider agreements to the repository
Manage contracting team email box; appropriately respond and triage of both internal and external messages to the appropriate parties. Respond to emails within established turnaround times
Research and respond to inquiries from providers and internal staff regarding contractual matters such as a provider’s participating status in the Aetna Better Health of Illinois provider network
Send out provider welcome packets to newly contracted providers
Support internal contract auditing processes as requested
Compile, summarize and report on the Health Plan’s compliance with contract submission rules and exception requests, communicating on at minimum, a monthly basis
Assist with miscellaneous claims projects/audits and reviewing contracts and plan documents
Ensures compliance of health plan, corporate, state, and federal regulations
Escalate issues, as necessary, to management in a timely manner
Work with members of Network Development and internal department staff to identify process improvement opportunities
Perform other duties as assigned