Manager Provider Data Services

CVS Health

2d

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Lead a team of Medicaid Provider Data Services Analyst responsible for loading and maintaining Medicaid Provider data within Aetna QNXT. Team will also include provider operations analyst and 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. Monitor Provider Data pends and keep inventory w/in KPIs and/or Metrics 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;

Requirements

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

Nice To Haves

• Strong collaboration skills
• Medicaid new state or expansion experience
• Strong reporting and data analysis skills and experience
• Ability to load balance and prioritize work in order 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 Analyst responsible for loading and maintaining Medicaid Provider data within Aetna QNXT.
• Team will also include provider operations analyst and 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.
• Monitor Provider Data pends and keep inventory w/in KPIs and/or Metrics
• 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

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