Provider Network Architect – Contracts & Data Integrity

CVS Health; Arizona; Hybrid; USD 47,000 - 122,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Job summary

CVS Health seeks a Network Configuration Specialist to enhance provider networks by applying in-depth contracting and data auditing knowledge. The role supports recruitment and negotiation efforts, ensuring compliance, quality, and financial goals.

Responsibilities include reviewing and auditing contracts, loading data into contract systems, and coordinating complex contracting activities. A Bachelor's degree or equivalent training, plus 3–5 years in Medicaid/claims, is required.

Qualifications

• 3-5 years of experience working with Medicaid and claims.
• Proficient in Microsoft Excel and SQL.
• Ability to work standard business hours from Monday-Friday, CST.

Responsibilities

• Assists with establishing and implementing results-based programs for the network operations area.
• Applies knowledge of network operations to provide feedback for decisions and growth.
• Implements review, design, loading, and auditing of complex contracts and fee schedules.
• Conducts routine research, analysis, and audits to protect data, contract integrity, and performance.
• Provides technical expertise for contracting questions.
• Coordinates contracting activities and reviews of contracts and language modifications.
• Coaches junior colleagues in techniques and processes.
• Performs other duties as needed.

Skills

Medicaid/claims experience

Attention to detail

Team collaboration

Critical thinking

Education

Bachelor's degree or specialized training/certification

Tools

Microsoft Excel

SQL

Job description

CVS Health seeks a Network Configuration Specialist to enhance provider networks by applying in-depth contracting and data auditing knowledge. The role supports recruitment and negotiation efforts, ensuring compliance, quality, and financial goals.

Responsibilities include reviewing and auditing contracts, loading data into contract systems, and coordinating complex contracting activities. A Bachelor's degree or equivalent training, plus 3–5 years in Medicaid/claims, is required.