Provider Network Configuration & Contracts Specialist

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

Job summary

CVS Health is seeking a Network Configuration Specialist to apply contracting and data audits to enhance provider networks while meeting accessibility, compliance, quality, and financial goals. You will review, design, and audit complex contracts and fee schedules and support negotiations.

The ideal candidate has 3-5 years of Medicaid and claims experience, strong Excel and SQL skills, and is available to work 40 hours weekly during Central Time.

Qualifications

• 3–5 years of experience working with Medicaid and claims.
• Demonstrated computer literacy, with an ability to navigate through internal and external computer systems, including Microsoft Excel and SQL.
• Ability to work standard business hours from Monday-Friday, supporting Central Standard Time.

Responsibilities

• Assists with establishing and implementing results-based programs and innovative initiatives for the network operations area, under general supervision.
• Applies in-depth knowledge of the network operations field to offer feedback for decisions and innovation strategies, in an effort to enhance organizational growth and visibility.
• Implements review, design, loading, and auditing of complex contracts, agreements, amendments, and/or fee schedules in contract management systems to enhance provider networks.
• Conducts routine research, analysis, and/or audits to identify issues and propose solutions to protect data, contract integrity, and performance.
• Provides technical expertise for questions regarding contracting and related systems and information contained.
• Coordinates complex contracting activities and implementation, as well as receipt and processing of contracts and documentation, in addition to pre-and post-signature review of contracts and language modification.
• Coaches more junior colleagues in techniques, processes, and responsibilities.
• Performs other duties as needed.

Skills

Medicaid/claims experience

Data analysis

Contract management systems

Education

High school diploma or GED

Tools

Microsoft Excel

SQL

Job description

CVS Health is seeking a Network Configuration Specialist to apply contracting and data audits to enhance provider networks while meeting accessibility, compliance, quality, and financial goals. You will review, design, and audit complex contracts and fee schedules and support negotiations.

The ideal candidate has 3-5 years of Medicaid and claims experience, strong Excel and SQL skills, and is available to work 40 hours weekly during Central Time.