Senior Network Relations Analyst

Job not on LinkedIn

🔥 1 minute ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $47k - $112.2k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

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