Provider Data Services Specialist (Must reside in Arizona)
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. The Provider Data Services Specialist compares and contrasts the provider system with network data and regulatory sources, in order to ensure accuracy of data feeds to various applications. This person manages provider records to ensure the provider directory is accurate for members, as well as that records are set up appropriately for claims processing. This role involves working in a fast-paced environment with several colleagues serving various functions.
Requirements
- 1-2 years of experience in customer service.
- Must reside in Arizona.
Nice To Haves
- Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
- Strong analytical and written/oral communication skills.
- 1-2 years of experience with SQL.
- 1-2 years of experience in Microsoft Excel.
- Previous experience working with QNXT.
- Previous experience with medical claims processing.
- Previous knowledge of medical billing.
Responsibilities
- Review and submit requests to update the provider module (within the QNXT system) for adds/changes related to Mercy Care Plan.
- Based on information from new contracts, expansion efforts, and routine provider changes, research the requests for updates to ensure they meet CMS (Centers for Medicare & Medicaid Services) and AHCCCS (Arizona Health Care Cost Containment System) regulations for member utilization.
- Utilize standard data elements for provider data to feed member directories, claim adjudication, encounter submissions, and regulatory utilization reports.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
