Network Relations Consultant
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 Relations Consultant acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.
Requirements
- Candidates are to reside within the State of Ohio
- Minimum 3 years recent Healthcare Claims experience
- Excellent analytical and problem-solving skills
- Strong communication, and presentation skills
- Strong Microsoft Office Suite experience (Word, Excel, TEAMs)
- Must be able to travel
Nice To Haves
- Recent Managed Care Network experience in Provider Relations or Network Relations
- Behavioral Health experience
- Medicaid experience
- Strong Microsoft Word, and Excel experience preferred
Responsibilities
- Conduct initial provider orientations as well as ongoing educational outreach.
- Conduct Provider Forums in conjunction with the team.
- Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface.
- Enhance account relationships by investigating, documenting, and resolving provider matters and effectively handling and responding to account changes and correspondence.
- Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance.
- Monitoring service capabilities and collaborating with cross-functional departments to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
- Supporting and assisting with operational activities that may include, but are not limited to, database management, and contract coordination.
- Submit Updates to Demographics or Roster modifications as needed for maintaining data integrity.
- Ensures compliance of health plan, corporate, state, and federal regulations during the course of business.
- Report to work on a consistent, regular basis during core business hours (8:00 am to 5:00pm).
- Provide responsive and professional customer service to both internal and external customers.
- Escalate issues, as necessary, to management in a timely manner.
- Meet or exceed established productivity standard of 10-12 provider visits a week.
- Conduct site visits when required.
- Additional Travel as needed.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
