Network Relations, Senior Analyst

CVS Health•Chalmers, IL

2d•$46,988 - $112,200•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 Senior Analyst, Network Relations is responsible for the accurate and timely validation and maintenance of critical provider information and inquiries. Staff are responsible for timely review, response, tracking, and routing of provider inquiries received via the Provider Engagement department email box and/or Provider Relationship Management System. Works closely with both internal and external business partners to ensure Provider inquiries are handled within a timely manner. Staff may be responsible for reviewing claims data and information. The Senior Network Relations Analyst is responsible for monthly Access and Availability monitoring as required by state regulatory requirements. Staff ensure adherence to the business and system requirements of internal customers as it pertains to other provider network management areas. Oversees receipt of and coordinates provider inquiries from the provider network and responsible for reviewing, documenting, tracking, and routing all issues to ensure providers receive a timely response and permanent resolution. Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided. Audits Rosters received in the provider relations department email box and works closely with the data team to ensure rosters submitted from providers are accurate. Oversees Access & Availability monthly monitoring process. Responsible for reviewing claims data in QNXT when provider’s inquiry involves claims payment adjudication. Excellent written and verbal communication skills. Conducts or participates in special projects and other duties as assigned.

Requirements

A minimum of 2-4 years of experience in healthcare operations, provider services, claims support, or payer-related administrative roles.
Working knowledge of healthcare claims processes, provider data management, and payer-provider interactions.
Strong attention to detail with the ability to validate provider data accurately.
Ability to manage multiple requests concurrently while meeting service-level expectations.
Strong written communication skills and ability to document work clearly and accurately.
Experience in Medical Terminology, CPT, ICD-10 codes, etc.
Experience working with the MS Office suite.
Other duties as assigned

Nice To Haves

Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards.
Strongly prefer the candidate resides in southern region of Illinois
Experience in Medical Terminology, CPT, ICD-10 codes, etc.
Experience using CRM systems, email ticketing tools, and healthcare administrative platforms.

Responsibilities

Accurate and timely validation and maintenance of critical provider information and inquiries.
Timely review, response, tracking, and routing of provider inquiries received via the Provider Engagement department email box and/or Provider Relationship Management System.
Works closely with both internal and external business partners to ensure Provider inquiries are handled within a timely manner.
Reviewing claims data and information.
Monthly Access and Availability monitoring as required by state regulatory requirements.
Ensure adherence to the business and system requirements of internal customers as it pertains to other provider network management areas.
Oversees receipt of and coordinates provider inquiries from the provider network and responsible for reviewing, documenting, tracking, and routing all issues to ensure providers receive a timely response and permanent resolution.
Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided.
Audits Rosters received in the provider relations department email box and works closely with the data team to ensure rosters submitted from providers are accurate.
Oversees Access & Availability monthly monitoring process.
Responsible for reviewing claims data in QNXT when provider’s inquiry involves claims payment adjudication.
Conducts or participates in special projects and other duties as assigned.