Project Manager, Provider Network Contract Validation

CVS Health•New Albany, OH

About The Position

Dynamic position within the new Network Contract Validation team, responsible for ensuring accurate payment of provider contracts through Health Rules Payor (HRP ) a claims processing platform. As part of the Network Contract Validation team, you will be responsible for reviewing, auditing, and coordinating the correction (if necessary) of HRP contract setup against contract intent and evaluate the pricing performance of claims. Accurate provider pricing configuration is critical to claims adjudication, and ultimately, having satisfied consumers and providers. By working closely with other areas of the company such as Network, Provider Data Services, Next Gen Provider Contract/Pricing team, Business Intent Review (BIR), HRP Provider Demographics, HRP Claims, HRP Product, legal/compliance, medical policy, and/or segment leaders this position will be responsible for ensuring the correct decisions were made when configuring contract and pricing features in HRP prior to contract implementation. Additionally, this role may participate with workgroups for process improvement.

Requirements

Experience with SCM (Strategic Contract Manager) and/or EPDB (Enterprise Provider Database), and/or HRP (Health Rules Payor)
Project Management
Basic understanding of Provider Contracting
Experience with EXCEL and working with large data files is critical.

Nice To Haves

Claims processing experience is desired.
Experience with Health Rules Payor is desired.
Proven track record in meeting project milestones and negotiating for resources.
Proven communication skills both written and verbal.
Proven ability to affect change/interpersonal skills.
Knowledge of Aetna's Commercial and Medicare products
Strong organization skills & time management
Able to independently resolve problems.
Ability to handle multiple assignments accurately and efficiently
Able to interpret data, translate it into meaningful information and draw conclusions

Responsibilities

Reviewing, auditing, and coordinating the correction (if necessary) of HRP contract setup against contract intent.
Evaluating the pricing performance of claims.
Ensuring the correct decisions were made when configuring contract and pricing features in HRP prior to contract implementation.
Participating with workgroups for process improvement.