Provider Relations Senior Analyst - Network Partnerships

CVS Health; Nebraska; Hybrid; USD 47,000 - 112,000; Full time

Job summary

CVS Health is hiring a Provider Relations Specialist to act as the primary resource for high-profile providers or groups, establishing and maintaining positive relationships while addressing complex issues regarding policies, plan design, contract language, service, and provider education. On-site presence is required periodically.

Role focuses on optimizing provider interactions, monitoring service capabilities, and supporting contract coordination, credentialing and education to ensure

Qualifications

• Working knowledge of business segment specific codes, products, and terminology.
• 3-5 years' experience with business segment specific policy, benefits, plan design and language.
• Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.

Responsibilities

• Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
• Monitors service capabilities and collaborates cross functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
• Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.
• Performs credentialing support activities as needed.
• Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
• Meets with key providers periodically to ensure service levels are meeting expectations.
• Manages the development of agenda, validates materials, and facilitates external provider meetings.
• May collaborate cross-functionally on the implementation of contracts or provider demographic updates.

Skills

Policy/Plan language knowledge

Communication skills

Problem solving

Education

Bachelor's degree

Job description

CVS Health is hiring a Provider Relations Specialist to act as the primary resource for high-profile providers or groups, establishing and maintaining positive relationships while addressing complex issues regarding policies, plan design, contract language, service, and provider education. On-site presence is required periodically.

Role focuses on optimizing provider interactions, monitoring service capabilities, and supporting contract coordination, credentialing and education to ensure