CVS Health
healthcare
NetworkRelations,SeniorAnalyst
“Network Relations, Senior Analyst at CVS Health. Skills: provider information validation, provider inquiry management, Access and Availability monitoring. Validate and maintain provider information and inquiries. Review, respond, track, and route provider inquiries”
What You'll Achieve.
ensure Provider inquiries are handled within a timely manner; ensure providers receive a timely response and permanent resolution
Industry & Context.
Must reside in the state of Illinois
What They're Looking For.
Must Have
2-4 years of experience in healthcare operations, provider services, claims support, or payer-related administrative roles, Working knowledge of healthcare claims processes, provider data management, and payer-provider interactions, attention to detail with the ability to validate provider data accurately, Ability to manage multiple requests concurrently while meeting service-level expectations, written communication skills and ability to document work clearly and accurately, Experience in Medical Terminology, CPT, ICD-10 codes, etc., Experience working with the MS Office suite, Must reside in the state of Illinois
Nice to Have
Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards, Strongly prefer the candidate resides in southern region of Illinois, Experience in Medical Terminology, CPT, ICD-10 codes, etc., Experience using CRM systems, email ticketing tools, and healthcare administrative platforms, Bachelor's degree preferred or a combination of professional work experience and education
What You'll Do.
Validate and maintain provider information and inquiries
and route provider inquiries
Monitor monthly Access and Availability
Ensure adherence to business and system requirements
Oversee receipt and coordinate provider inquiries
Review and analyze data
Oversee Access & Availability monitoring process
Review claims data in QNXT
Participate in special projects
How You'll Work.
Team & Collaboration
Works closely with both internal and external business partners; Works closely with the data team
Communication Scope
Excellent written and verbal communication skills; written communication skills and ability to document work clearly and accurately
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