Strategic Behavioral Health Provider Relations Lead

4004 Aetna Medicaid Administrators; Louisiana; Hybrid; USD 54,000 - 119,000; Full time

Job summary

CVS Health is seeking an experienced professional to act as the primary resource for Medicaid Behavioral Health providers and groups, building and maintaining positive relationships while addressing complex issues related to Medicaid policies, contracts, and provider education.

You will collaborate cross-functionally to support provider credentialing, contract interpretation, and cost initiatives, with regular meetings and trainings.

Qualifications

• Minimum of 5 years' work experience in healthcare.
• Minimum of 3 years' experience in Medicaid Managed Care business segment servicing providers with exposure to benefits and/or contract interpretation.
• Minimum of 2 years’ experience working with providers and contracts in the behavioral health sector.
• Working knowledge of business segment specific codes, products, and terminology.
• Proficiency in Microsoft Office Suite, including Excel, Word, and PowerPoint.

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 needs are met and escalated issues related to claims payment, contract interpretation or parameters, and provider data accuracy are resolved.
• Supports or assists with operational activities including database management and contract coordination.
• Performs credentialing support activities as needed.
• Educates Medicaid providers to ensure compliance with contract policies, plan design, compensation process, technology, policies and procedures.
• Meets with key Providers at regular intervals to ensure service levels meet expectations.
• Manages the development of agenda, validates materials, and facilitates external provider meetings.
• Collaborates cross-functionally with implementation of large provider systems to manage cost drivers and execute cost initiatives.
• May provide guidance and training to less experienced team members.
• Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.
• Collaborate with Provider Enablement & Strategy on communications, workflows, reporting needs, and HUB support.

Education

Bachelor's degree preferred

Tools

Excel

Word

PowerPoint

Job description

CVS Health is seeking an experienced professional to act as the primary resource for Medicaid Behavioral Health providers and groups, building and maintaining positive relationships while addressing complex issues related to Medicaid policies, contracts, and provider education.

You will collaborate cross-functionally to support provider credentialing, contract interpretation, and cost initiatives, with regular meetings and trainings.