Senior Network Relations Analyst

Vaga não está no LinkedIn

🕒 5 dias atrás

🌽 Illinois – Remoto

🌽 Illinois – Remote

💵 $46.988 - $112.200 / ano

⏰ Tempo Integral

🟠 Sênior

🧐 Analista

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CVS Health

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1963

⚕️ Seguro de Saúde

🛒 Varejo

🧘 Bem-estar

Healthcare Insurance • Retail • Wellness

CVS Health é uma empresa líder de saúde nos Estados Unidos, dedicada a ampliar o acesso e a acessibilidade ao cuidado. A empresa adota uma abordagem abrangente que inclui serviços de saúde, seguro saúde e gestão de benefícios farmacêuticos (PBM). Por meio de suas subsidiárias, como Aetna e CVS Caremark, a CVS Health oferece uma variedade de serviços que promovem o bem-estar, a gestão de condições de saúde e a cobertura acessível de medicamentos prescritos. A CVS Health opera farmácias de bairro, oferece serviços de farmácia por correspondência e gerencia programas de medicamentos de especialidade, com o objetivo de tornar o cuidado com a saúde conveniente e acessível para todos. Movida pela missão de conectar pessoas a serviços essenciais de cuidado, a CVS Health está comprometida em fomentar comunidades mais saudáveis e apoiar o bem-estar de todas as pessoas.

Descrição

• responsible for the accurate and timely validation and maintenance of critical provider information and inquiries • responsible for timely review, response, tracking, and routing of provider inquiries received via the Provider Engagement department email box and/or Provider Relationship Management System • works closely with both internal and external business partners to ensure Provider inquiries are handled within a timely manner • responsible for reviewing claims data and information • responsible for monthly Access and Availability monitoring as required by state regulatory requirements • 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.

🎯 Requisitos

• A minimum of 2-4 years of experience in healthcare operations, provider services, claims support, or payer-related administrative roles • Working knowledge of healthcare claims processes, provider data management, and payer-provider interactions • Strong attention to detail with the ability to validate provider data accurately • Ability to manage multiple requests concurrently while meeting service-level expectations • Strong written communication skills and ability to document work clearly and accurately • Experience in Medical Terminology, CPT, ICD-10 codes, etc. • Experience working with the MS Office suite.

🏖️ Benefícios

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility