Medicaid Provider Operations Support, CVS Health

CVS Health

Location:
United States, Michigan

Category:
IT - Administration

Contract Type:
Employment contract

Salary:

18.50 - 35.29 USD / Hour

Save Job

Job offer has expired

Job Description:

The Medicaid Provider Operations Support (MPOS) team serves as the primary Point of Contact for the Provider Data Services team and works on data cleanup reports for multiple Health Plans within Medicaid regions. This role involves issue resolution, data setup guidance, team development, and ensuring compliance with health plan requirements.

Job Responsibility:

Provides guidance to all analysts on issue resolution and accurate provider data setup, in alignment with established standards and Health Plan-specific requirements
Collaborate with team members to identify, review, and research issues in support of effective solutions
Support the review and potential revision of documentation based on new guidance provided by the Liaison
Supports the identification and resolution of internal performance issues, as well as team development opportunities
Enhances the health plan’s confidence through reliable partnership and consistent engagement
Reduces turnaround time for issue resolution by minimizing dependency on Health Plan responses
Minimizes repeated outreach to the health plan through proactive issue resolution and knowledge sharing
Minimizes impact on overall productivity
Manage team production workflows to ensure timely and accurate case completion
Attending all regularly scheduled meetings as assigned
Reviewing escalated requests, ensuring timely issue resolution, and communicating outcomes, while prioritizing issues as needed
Supporting and maintaining Health Plan Data Sheets by reviewing and updating them to reflect accurate information as new standards are implemented
Serving as the Subject Matter Expert and Point of Contact for provider data clean-up across all Medicaid states
Identify and escalate significant trends or concerns within designated areas to MPOS leadership
Assigning data clean up tasks to analysts based on reports from various states
Responding daily to inquiries and emails related to provider data across multiple health plans

Requirements:

Minimum of 1 year of experience in provider data management
Minimum of 1 year of direct communication experience with internal teams and external partners
Proficiency in managing provider data, supporting operations, and navigating network structures
Proficient in Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook
Extensive knowledge of problem-solving methodologies and effective troubleshooting strategies

Nice to have:

SQL experience
QuickBase experience
QNXT system knowledge
Excel Skills: VLOOKUPS and Pivot Tables

What we offer:

Affordable medical plan options
401(k) plan including matching company contributions
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 addressing different needs and preferences including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access

Additional Information:

Job Posted:
November 01, 2025

Expiration:
November 01, 2025

Employment Type:

Fulltime

Work Type:

Remote work

View All Jobs In This Company

Job Link Share:

Medicaid Provider Operations Support