Network Relations Senior Analyst

CVS Health • Whitpain Township, PA

3d

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 Sr Analyst will join a rental vendor and provider operations team within Network Strategy & Provider Experience and will develop, maintain, and enhance rental vendor and provider relationships including with strategic network vendors and partners including facilities and physicians which serve as contractual networks of care for our members. Serve as the subject matter expert in support of contracting initiatives and data audits to enhance vendor program performance and provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals. Responsible for reviewing, building, and auditing complex contract and network data; may support recruitment efforts and collaborate on negotiations as needed.

Requirements

• 5+ years related provider service experience successfully resolving and responding to provider reimbursement inquiries.
• Advanced user experience in provider data/network setup and maintenance and claims research in core systems (ACAS, PRMS, EPDB, SCM).
• Demonstrated root cause analysis and problem resolution skills.
• Strong meeting facilitation, organizational, and documentation skills.
• Strong communication, critical thinking, and interpersonal skills.
• Advanced Excel and Crystal reporting skills.
• Associate degree or equivalent combination of education and health care operations experience.

Nice To Haves

• Experience working w/ cross-functional teams and IT to resolve complex bi-directional data exchange issues including member/provider data rosters, and capitation rosters.
• Experience working w/ approval committees such as HOPP/NVDOC/NPL to update internal/external reference tools.
• Working knowledge of standard provider contracts, terms, and language.

Responsibilities

• Responsible for reviewing, building, loading, and auditing complex contracts, agreements, amendments and/or fee schedules in contract management systems.
• Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity, and performance.
• Manages and performs scheduled program operations reporting and reconciliation activities.
• Provides technical expertise for questions related to contracting and related systems and information contained.
• Partner across the organization to support network development, maintenance, refinement activities, regulatory filings, migration, and rate activities.
• Coordinate program operations activities, lead rental vendor implementation and provider onboarding work stream activities
• Coordinate receipt and processing of provider network data including demographics, reimbursement, contracts, and documentation; may support pre-and post-signature review of contracts and language modification.
• Supports negotiations via handling of system set up within Aetna systems for Commercial programs and contracts.
• Conduct service activities such as provider education, technology usage, or process/policy updates.
• Coordinate data analysis to identify root causes, develop/contact recruitment targets in support of network management expansion initiatives or analyze market data for outreach mailings to desired expansion targets.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees