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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. 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.
Job Responsibility:
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
Bachelor's degree preferred or a combination of professional work experience and education
Nice to have:
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.
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