Overview
Remote
USD 46,988.00 - 91,800.00 per year
Full Time
Skills
Brand
Health care
System requirements
Network
Routing
Auditing
QNXT
Network administration
Medical terminology
ICD-9
Microsoft Excel
Life insurance
Law
Job Details
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
The Network Relations Analyst is responsible for the accurate and timely validation and maintenance of critical provider information and inquiries. Staff is responsible for timely review, response, tracking, and routing of provider inquiries received via the provider relations department email box. Works closely with both internal and external business partners to ensure provider and member issues are handled timely. Staff may be responsible for review of claims data and information. Network Relations Analyst is responsible for monthly Access and Availability monitoring as required by state regulatory requirements. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas.
Oversees receipt of and coordinates provider inquiries from the provider network and responsible for reviewing, documenting, tracking, and routing all issues to ensure providers receive a timely response and permanent resolution.
Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided.
Audits Rosters received in the provider relations department email box and works closely with the data team to ensure rosters submitted from providers are accurate.
Oversees Access & Availability monthly monitoring process.
Responsible for reviewing claims data in QNXT when provider's inquiry involves claims payment adjudication.
Conducts or participates in special projects and other duties as assigned.
Required Qualifications
Minimum 1 - 2 years managed care experience.
Preferred Qualifications
3+ years Provider Claims and/or Provider Network Administration experience
Experience in Medical Terminology, CPT, ICD-9 codes, etc.
Access and Excel - intermediate skill level (or higher)
Education
Associate degree or equivalent experience.
Pay Range
The typical pay range for this role is:
$46,988.00 - $91,800.00
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
We anticipate the application window for this opening will close on: 12/27/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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
The Network Relations Analyst is responsible for the accurate and timely validation and maintenance of critical provider information and inquiries. Staff is responsible for timely review, response, tracking, and routing of provider inquiries received via the provider relations department email box. Works closely with both internal and external business partners to ensure provider and member issues are handled timely. Staff may be responsible for review of claims data and information. Network Relations Analyst is responsible for monthly Access and Availability monitoring as required by state regulatory requirements. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas.
Oversees receipt of and coordinates provider inquiries from the provider network and responsible for reviewing, documenting, tracking, and routing all issues to ensure providers receive a timely response and permanent resolution.
Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided.
Audits Rosters received in the provider relations department email box and works closely with the data team to ensure rosters submitted from providers are accurate.
Oversees Access & Availability monthly monitoring process.
Responsible for reviewing claims data in QNXT when provider's inquiry involves claims payment adjudication.
Conducts or participates in special projects and other duties as assigned.
Required Qualifications
Minimum 1 - 2 years managed care experience.
Preferred Qualifications
3+ years Provider Claims and/or Provider Network Administration experience
Experience in Medical Terminology, CPT, ICD-9 codes, etc.
Access and Excel - intermediate skill level (or higher)
Education
Associate degree or equivalent experience.
Pay Range
The typical pay range for this role is:
$46,988.00 - $91,800.00
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
We anticipate the application window for this opening will close on: 12/27/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.