Network Configuration Specialist

CVS Health•Work At Home-Illinois, IL

3d•$46,988 - $122,400•Remote

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 The Network Configuration Specialist applies in-depth knowledge of contracting initiatives and data audits to enhance provider networks, while meeting and exceeding accessibility, compliance, quality, and financial goals. This person conducts routine review, design, and auditing for complex contract and network data, supports recruitment efforts, and collaborates on negotiations as needed.

Requirements

3-5 years of experience working with Medicaid and claims.
Demonstrated computer literacy, with an ability to navigate through internal and external computer systems, including Microsoft Excel and SQL.
Ability to work standard business hours from Monday-Friday, supporting Central Standard Time.

Nice To Haves

Ability to effectively participate in a multi-disciplinary team including internal and external participants.
Ability to use critical thinking skills to analyze claims, contracts, and state regulations for configuration.
Strong customer service skills to coordinate service delivery, including attention to customers, sensitivity to issues, proactive identification, and resolution of issues, in order to promote positive outcomes for members and providers.
Working knowledge of skills supporting execution and delivery (planning, delivering, and supporting).
Working knowledge of business intelligence.
Strong problem solving and decision-making skills.
Ability to collaborate within a team, as well as interdepartmentally.
Ability to self-motivate and drive own growth regularly.
Bachelor’s degree or specialized training/certification.

Responsibilities

Assists with establishing and implementing results-based programs and innovative initiatives for the network operations area, under general supervision.
Applies in-depth knowledge of the network operations field to offer feedback for decisions and innovation strategies, in an effort to enhance organizational growth and visibility.
Implements review, design, loading, and auditing of complex contracts, agreements, amendments, and/or fee schedules in contract management systems to enhance provider networks.
Conducts routine research, analysis, and/or audits to identify issues and propose solutions to protect data, contract integrity, and performance.
Provides technical expertise for questions regarding contracting and related systems and information contained.
Coordinates complex contracting activities and implementation, as well as receipt and processing of contracts and documentation, in addition to pre- and post-signature review of contracts and language modification.
Coaches more junior colleagues in techniques, processes, and responsibilities.
Performs other duties as needed.