Senior Analyst, Provider Relations

CVS Health

2d

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 The Senior Analyst, Provider Relations is responsible for the accurate and timely validation and maintenance of critical provider information and inquiries. Staff are responsible for timely review, response, tracking, and routing of provider inquiries received via the Provider Engagement department email box and/or Provider Relationship Management System. Works closely with both internal and external business partners to ensure Provider inquiries are handled within a timely manner. Staff may be responsible for reviewing claims data and information. The Senior Network Relations Analyst is responsible for monthly Access and Availability monitoring as required by state regulatory requirements. Staff ensure adherence to the business and system requirements of internal customers as it pertains to other provider network management areas. Oversees receipt of and coordinates provider inquiries from the provider network and responsible for reviewing, documenting, tracking, and routing all issues to ensure providers receive a timely response and permanent resolution. Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided. Audits Rosters received in the provider relations department email box and works closely with the data team to ensure rosters submitted from providers are accurate. Oversees Access & Availability monthly monitoring process. Responsible for reviewing claims data in QNXT when provider’s inquiry involves claims payment adjudication. Excellent written and verbal communication skills. Conducts or participates in special projects and other duties as assigned.

Requirements

• A minimum of 5 years' work experience in healthcare.
• 2-3 years experience in Medical Terminology, CPT, ICD-10 codes, etc.
• Experience working with the MS Office suite.
• Excellent written and verbal communication skills.

Nice To Haves

• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards.
• Experience in Medical Terminology, CPT, ICD-10 codes, etc.

Responsibilities

• Responsible for the accurate and timely validation and maintenance of critical provider information and inquiries.
• Responsible for timely review, response, tracking, and routing of provider inquiries received via the Provider Engagement department email box and/or Provider Relationship Management System.
• Works closely with both internal and external business partners to ensure Provider inquiries are handled within a timely manner.
• Responsible for monthly Access and Availability monitoring as required by state regulatory requirements.
• Oversees receipt of and coordinates provider inquiries from the provider network and responsible for reviewing, documenting, tracking, and routing all issues to ensure providers receive a timely response and permanent resolution.
• Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided.
• Audits Rosters received in the provider relations department email box and works closely with the data team to ensure rosters submitted from providers are accurate.
• Oversees Access & Availability monthly monitoring process.
• Responsible for reviewing claims data in QNXT when provider’s inquiry involves claims payment adjudication.
• Conducts or participates in special projects and other duties as assigned.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level