Senior Analyst, Network Relations

CVS Health•Work At Home-Texas, TX

4d•$46,988 - $102,000

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 Acts as the primary resource for assigned, 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 collaborate 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 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 re-contracting 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+ years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation.
Working knowledge of business segment specific codes, products, and terminology.
3-5 years experience with business segment specific policy, benefits, plan design and language.
Strong verbal and written communication skills.
Strong interpersonal skills.
Strong problem resolution skills.
Strong critical thinking skills.

Nice To Haves

5 + years' experience with business segment specific policy, benefits, plan design and language.

Responsibilities

Acts as the primary resource for assigned providers or groups to establish, oversee, and maintain positive relationships.
Assists with or responds 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 constituent needs are met.
Resolves escalated issues related to claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information.
Supports or assists with operational activities such as database management and contract coordination.
Performs credentialing support activities as needed.
Educates providers on contract policies, plan design, compensation processes, technology, policies, and procedures.
Meets with key providers periodically to ensure service levels meet expectations.
Manages the development of agendas, validates materials, and facilitates external provider meetings.
Collaborates cross-functionally on the implementation of large provider systems, cost initiatives, and problem resolution.
Conducts provider recruitment, contracting, or re-contracting activities.
Assists with complex contracting and discussions.
May provide guidance and training to less experienced team members.