Payer Relations Lead Coordinator

CVS Health•Cumberland, RI

29d•$19 - $39•Hybrid

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryThe Payer Enrollment Lead Coordinator is responsible for ensuring the timely and accurate processing of payer enrollment applications, including initial submissions and revalidations for clinics and providers. This role supports compliance with Medicaid and Commercial programs by maintaining quality control over individual enrollment applications and resolving claims issues within the corporate billing system. This role maintains credentialing and billing systems with updated provider information from Medicaid and Commercial payers, and ensuring ongoing compliance through credentialing, re-credentialing, and audit procedures. The coordinator will proactively contact providers upon receipt of revalidation notices to obtain necessary documentation and verify current information, while also managing escalations with field teams. Additionally, the role involves identifying and analyzing trends or issues related to payer enrollment, communicating findings and potential impacts to management, and implementing strategies to minimize denials and application deactivations-ultimately reducing key metrics such as DSO, cost to collect, aged claims, and bad debt.

Requirements

2 + years of general work experience.
2 + years of experience using excel.
2 + years of experience using outlook in a professional setting.
Please note: This is a hybrid position with a set schedule that requires regular in office attendance.
High School Diploma or GED

Nice To Haves

Medicare/Medicaid experience on the Provider side
Adept at problem solving and decision-making skills
Ability to work independently
Willingness to learn

Responsibilities

Submits, maintains, and monitors applications for Initial enrollment and Revalidation with Government Medicaid Payer and Commercial Payers for Clinics and Providers in order to ensure active participation.
Provides assistance in developing and improving payer workflow while ensuring compliance with the company's regulatory, safety, quality, and confidentiality protocols and standards.
Responsible for ensuring the timely and accurate submission of Group and Provider enrollment applications for Medicaid and Commercial programs, supporting compliance and operational efficiency across payer relations.
Follows up on status and escalates as needed to overcome barriers and proactively address and resolve requests and issues.
Responsible for minimizing the deactivation of government program applications by adhering to established quality control procedures. Serves as a key point of contact for escalated claim issues received from internal departments, coordinating with payers to identify and implement solutions. Communicates resolutions and relevant updates to appropriate internal stakeholders to ensure alignment and continuity
Responsible for maintaining accurate and up-to-date credentialing and billing systems by updating provider information upon inquiry or receipt from payers. Develops and maintains state-specific summaries, policies, procedures, and training modules to support operational consistency. Conducts research to identify potential issues, formulates solutions, and ensures timely resolution. Communicates updates and relevant information to field teams as needed to ensure alignment and awareness.
Conducts research and analysis of trends related to claims, providers, and clinics to identify opportunities for process improvements and system efficiencies. Maintains a weekly issue log documenting all provider-payer issues by state. Collaborates with Senior and Centralized Provider Managers to ensure accurate provider enrollment across locations, reporting discrepancies and recommending corrective actions. Reviews claims on trends, errors, enrollment status, insurance package accuracy, and non-billable services to support resolution and operational integrity.

Benefits

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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