Sr Analyst,Ntwrk Relations

CVS Health•Work At Home-Kansas, KS

1d•$46,988 - $91,800•Hybrid

About The Position

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 as need. This position requires individual to be on-site from time to time. • 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 contracts or provider demographic updates.

Requirements

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, interpersonal, problem resolution and critical thinking skills.

Nice To Haves

6+ years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation.

Responsibilities

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 contracts or provider demographic updates.