Provider Network Configuration Specialist

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in North Carolina is seeking a Network Configuration Specialist to enhance provider networks through data audits and contract management. This role focuses on implementing results-based programs while aligning with accessibility, quality, and financial goals.

You will review contracts, feed improvements, and support negotiations, with a cross-functional team. The ideal candidate has 3–5 years of Medicaid/claims experience, proficiency in Excel and SQL, and the ability to work standard

Qualifications

• 3–5 years of Medicaid and claims experience.
• Proficient with Excel and SQL.
• Ability to work standard business hours CST.

Responsibilities

• Establish and implement results-based programs for network operations.
• Offer feedback to decisions and strategy to enhance growth.
• Design, load, and audit complex contracts and fee schedules.
• Research, analyze, and audit to protect data and performance.
• Provide technical contracting expertise for systems questions.
• Coordinate contract activities and post-signature review.
• Coach junior colleagues in processes and responsibilities.
• Perform other duties as needed.

Skills

Medicaid experience

Excel

SQL

CST hours

Education

High school diploma or GED

Bachelor's degree

Job description

CVS Health in North Carolina is seeking a Network Configuration Specialist to enhance provider networks through data audits and contract management. This role focuses on implementing results-based programs while aligning with accessibility, quality, and financial goals.

You will review contracts, feed improvements, and support negotiations, with a cross-functional team. The ideal candidate has 3–5 years of Medicaid/claims experience, proficiency in Excel and SQL, and the ability to work standard