Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary: Acts as the primary resource for assigned, high profile providers and/or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.
-
Optimizes interactions with assigned providers andinternal business partners to establish and maintainproductive, professional relationships.
-
Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents aremet and that escalated issues related but not limited to,claims payment, contract interpretation or parameters,and accuracy of provider contract or demographicinformation are resolved.
-
Supports or assists with operational activities that mayinclude, but are not limited to, database management,and contract coordination.
-
Performs credentialing support activities as needed.
-
Educates Medicaid providers as needed to ensurecompliance with contract policies and parameters, plandesign, compensation process, technology, policies, andprocedures.
-
Meets with key providers regular intervals to ensureservice levels are meeting expectations.
-
Manages the development of agenda, validatesmaterials, and facilitates external provider meetings.
-
Collaborate cross-functionally on theimplementation of large provider systems, to managecost drivers and execute specific cost initiatives tosupport business objectives and to identify trends andenlist assistance in problem resolution.
-
Assist with standard provider recruitment, contracting, orre- contracting activities and assist with more complexcontracting and discussions as needed by businesssegment.
-
May provide guidance and training to less experiencedteam members.
Required Qualifications:
-
Minimum of 3 years' experience in Medicaid Managed Carebusiness segment environment servicing providers withexposure to benefits and/or contract interpretation.
-
Strong verbal and written communication, interpersonal,problem resolution and critical thinking skills.
-
Working knowledge of business segment specific codes,products, and terminology.
Preferred Qualifications:
- Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards.
Education
- Bachelor's degree preferred or a combination of professional work experience and education.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$54,300.00 - $119,340.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)
We anticipate the application window for this opening will close on: 03/29/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
