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At CVS Health, we’re building a world of health around every consumer. This role is responsible for maintaining relationships with high-profile providers or groups, resolving complex issues, ensuring compliance, and supporting operational activities.
Job Responsibility:
Acts as the primary resource for assigned, high profile providers or groups to establish, oversee, and maintain positive relationships
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 are resolved
Supports or assists with business partner and operational activities that may include, database management, introduction and expansion of programs, medical record retrieval, 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 virtually or in person with key providers periodically to ensure service levels are meeting expectations
Manages the development of meeting agendas, validates materials, coordinates business partner meeting attendance, maintains meeting minutes and facilitates external provider meetings
May collaborate cross-functionally on the implementation of contracts or provider demographic updates
Assists with standard provider recruitment, contracting, or re-contracting activities
Requirements:
Working knowledge of business segment specific billing codes, plan products, and terminology
3+ years' experience in business segment environment servicing providers with exposure to benefits, credentialing, experience with claims and billing and/or contract interpretation
Strong verbal and written communication, interpersonal, problem resolution, presentation and critical thinking skills
Nice to have:
5+ years' experience in business segment environment servicing providers with exposure to benefits, credentialing, experience with claims and billing and/or contract interpretation
What we offer:
Affordable medical plan options
401(k) plan including matching company contributions
employee stock purchase plan
no-cost programs including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
benefit solutions like paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access
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