Network Relations, Senior Analyst

CVS Health•Work At Home-Texas, TX

1d•$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: Senior Analyst Provider Engagement Network Solutions Team is responsible for managing and resolving provider related inquiries and operational processes to ensure seamless network participation and compliance. This role involves direct interaction with dental providers, and internal teams to maintain accurate provider data, resolve claim issues, and support credentialing and contracting activities.

Requirements

Bachelor’s degree in dental, healthcare administration, business, or related field (or equivalent experience).
5+ years of experience in dental, provider relations, network management, or healthcare operations/administration.
Strong understanding of PPO networks, credentialing processes, and claims administration.
Excellent communication and problem-solving skills.
Proficiency in MS Office and provider management systems.
Detail-oriented with strong organizational skills.
Ability to manage multiple priorities in a fast-paced environment.
Knowledge of regulatory requirements and compliance standards.
Customer focused with a commitment to service excellence.

Nice To Haves

Experience in the dental field and knowledge of PPO, and Medicare networks.

Responsibilities

Investigate and resolve provider claim issues, ensuring timely and accurate adjudication.
Submitting demographic changes and updates to maintain accurate provider records in all systems.
Handle Complaints grievance and appeals requests, including contract generation and amendments for PPO networks.
Manage opt-in and opt-out requests for provider participation in various networks.
Facilitate credentialing requests and ensure compliance with organizational and regulatory standards.
Collaborate with DOI (Department of Insurance) and SIU (Special Investigations Unit) for compliance matters and fraud prevention.
Deliver guidance and training to providers regarding policies, procedures, and online portal navigation.
Send EFT (Electronic Funds Transfer), ERA (Electronic Remittance Advice), and VCC (Virtual Credit Card) enrollment requests for processing.