Network Relations, Senior Analyst

CVS Health•Work At Home-North Carolina, NC

2d•$46,988 - $91,800•Onsite

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. Acts as the primary liaison for assigned geography of integrated providers, (i.e. market/regional/national, large group) to establish, oversee, and maintain provider risk management and positive relationships and supports high value initiative activities. Conducts provider education, ensures contract compliance, provider communication, claims research and assists with resolution Implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets.

Requirements

Must be experienced in working with all reimbursement payment methodologies
3-5 years of provider relations and/or network management experience required
Experienced in working with large provider groups, capitated agreements, behavioral health provider
Must have excellent written, oral, and interpersonal communication skills
Computer literate in Word, Excel, Microsoft Office
Must be flexible and able to handle a highly, fast-paced environment
Must reside in North or South Carolina

Nice To Haves

Knowledge of Medicare programs
Knowledge of various Behavioral Health and Commercial payment methodologies
Medical claims processing knowledge
Experience working within Provider Databases (i.e. EPDB) a plus
Critical thinking, problem resolution and ability to work independently
Excellent time management skills
Must be flexible and able to handle a highly, fast-paced environment

Responsibilities

Acts as the primary liaison for assigned geography of integrated providers, (i.e. market/regional/national, large group) to establish, oversee, and maintain provider risk management and positive relationships and supports high value initiative activities.
Conducts provider education, ensures contract compliance, provider communication, claims research and assists with resolution
Implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets.