Senior Analyst, Network Relations

CVS Health•Washington, NV

12d•$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. Acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships. Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved. Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination. Performs credentialing support activities as needed. Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures. Meets with key providers periodically to ensure service levels are meeting expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings. May collaborate cross functionally on the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution. Conduct standard provider recruitment, contracting, or recontracting activities and assist with more complex contracting and discussions as needed by business segment. May provide guidance and training to less experienced team members.

Requirements

3-5 years knowledge of business segment specific codes, products, and terminology.
3-5 years of Microsoft Applications experience.
Strong verbal and written communication skills.
Strong interpersonal skills.
Strong problem resolution skills.
Strong critical thinking skills.
Exceptional organizational skills.
Exceptional multitasking skills.
Exceptional time management skills.
Ability to effectively balance competing priorities in a fast-paced environment.
Capacity to assess urgent needs.
Ability to adapt to changing demands.
Ability to manage multiple assignments simultaneously while consistently meeting deadlines.
Ability to maintain a high level of accuracy and quality.

Nice To Haves

6+ years knowledge of business segment specific codes, products, and terminology.

Responsibilities

Establish, oversee, and maintain positive relationships with assigned high-profile providers or groups.
Assist with or respond to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues.
Provide provider education.
Optimize interactions with assigned providers and internal business partners.
Monitor service capabilities and collaborate cross-functionally to ensure constituent needs are met.
Resolve escalated issues related to claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information.
Support or assist with operational activities such as database management and contract coordination.
Perform credentialing support activities as needed.
Educate providers on contract policies, plan design, compensation process, technology, policies, and procedures.
Meet with key providers periodically to ensure service levels are meeting expectations.
Manage the development of agendas, validate materials, and facilitate external provider meetings.
Collaborate cross-functionally on the implementation of large provider systems.
Manage cost drivers and execute specific cost initiatives to support business objectives.
Identify trends and enlist assistance in problem resolution.
Conduct standard provider recruitment, contracting, or recontracting activities.
Assist with more complex contracting and discussions.
Provide guidance and training to less experienced team members.