Manager Medicaid Provider Data Services

CVS Health

9d

About The Position

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Lead a team of Medicaid Provider Data Services Analysts responsible for loading and maintaining Medicaid Provider data within Aetna QNXT. Team will also include provider operations analyst and potential pre-cred support for implementation activities. Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with member services and other internal departments. Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions. Monitors staff performance, including weekly staff metrics; coaches and mentors’ staff on performance issues or concerns.

Requirements

• 3+ years of recent and related experience in Provider Operations, Provider Relations, or Network operations.
• 1+ years of experience in Medicaid provider operations.
• At least 1 year of experience with ensuring the provider data entered into the provider database is accurate and the provider documentation is complete and accurate.
• 1+ years of experience in managing, coaching, and leading a team of Provider Data Services Analysts.
• At least 1 years of experience leading or managing a production-oriented team.

Nice To Haves

• Strong collaboration skills.
• Strong reporting and data analysis skills and experience.
• Ability to load balance and prioritize work to meet key performance metrics around TAT and quality.
• Drive and oversee productivity of staff.
• Experience with new Medicaid state implementation related to provider requirements.
• Leadership skills including staff development.
• Critical thinking and problem-solving skills.
• Familiarity with Provider Data/Enterprise systems.
• Strong skills in Microsoft products.
• QuickBase knowledge.

Responsibilities

• Lead a team of Medicaid Provider Data Services Analysts responsible for loading and maintaining Medicaid Provider data within Aetna QNXT.
• Team will also include provider operations analyst and potential pre-cred support for implementation activities.
• Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc.
• Coordinates provider status information with member services and other internal departments.
• Recruits, develops, and motivates staff.
• Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
• Monitors staff performance, including weekly staff metrics; coaches and mentors’ staff on performance issues or concerns.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees