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Senior Network Relations Analyst

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States, Frankfort

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Category:
IT - Administration

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Contract Type:
Employment contract

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Salary:

46988.00 - 91800.00 USD / Year

Job Description:

The Senior Network Relations Analyst 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:

  • Accurate and timely validation and maintenance of critical provider information and inquiries
  • 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
  • Reviewing claims data and information
  • Monthly Access and Availability monitoring as required by state regulatory requirements
  • 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
  • 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

Requirements:

  • A minimum of 2 years' work experience in healthcare
  • Experience in Medical Terminology, CPT, ICD-10 codes, etc.
  • Experience working with the MS Office suite (Excel)
  • Excellent written and verbal communication skills
  • Travel up to 25%
  • This position has to reside in KY (within 3 hours of the capital)

Nice to have:

  • Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards
  • Bachelor's Degree
What we offer:
  • Affordable medical plan options
  • 401(k) plan with matching company contributions
  • Employee stock purchase plan
  • No-cost programs including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
  • Paid time off
  • Flexible work schedules
  • Family leave
  • Dependent care resources
  • Colleague assistance programs
  • Tuition assistance
  • Retiree medical access

Additional Information:

Job Posted:
October 23, 2025

Expiration:
November 03, 2025

Employment Type:
Fulltime
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