Network Relations Manager (Central Texas)

CVS Health•Fort Worth, TX

9d•$60,300 - $132,600•Remote

About The Position

Acts as the primary resource for assigned, high profile providers and/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 Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships. Monitors service capabilities and collaborate cross-functionally 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. Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination. Performs credentialing support activities as needed. Educates Medicaid providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures. Meets with key Providers at regular intervals to ensure service levels meet expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings. Collaborate cross-functionally with the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution. May provide guidance and training to team members. Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills. Collaborate with Provider Enablement & Strategy on Provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support. Facilitate internal meetings and coordinate external partner meetings to ensure effective communication and collaboration. Other duties as assigned.

Requirements

A minimum of 5 years' work experience in healthcare.
Minimum of 3 years' experience in Medicaid Managed Care business segment environment servicing providers with exposure to benefits and/or contract interpretation.
Working knowledge of business segment specific codes, products, and terminology.
Demonstrated expertise in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
Candidates must reside in the Central Texas Region.

Nice To Haves

Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards.
Experience in Medical Terminology, CPT, ICD-10 codes, etc.

Responsibilities

Establish, oversee, and maintain positive relationships with assigned, high profile providers and/or groups.
Assist with or respond to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues.
Provide provider education.
Optimize interactions with assigned providers and internal business partners.
Monitor service capabilities and collaborate cross-functionally to ensure constituent needs are met.
Resolve escalated issues related to claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information.
Support or assist with operational activities such as database management and contract coordination.
Perform credentialing support activities as needed.
Educate Medicaid providers on contract policies, plan design, compensation process, technology, policies, and procedures.
Meet with key Providers at regular intervals to ensure service levels meet expectations.
Manage the development of agenda, validate materials, and facilitate external provider meetings.
Collaborate cross-functionally with the implementation of large provider systems to manage cost drivers and execute specific cost initiatives.
Identify trends and enlist assistance in problem resolution.
Provide guidance and training to team members.
Collaborate with Provider Enablement & Strategy on Provider-facing communications, desktops, workflows, external trainings, reporting needs, and HUB support.
Facilitate internal meetings and coordinate external partner meetings.