Analyst – Medicaid Network Operations

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🔥 1 hour ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $47k - $112.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🌐 Network Operations

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• Perform thorough reviews of all incoming contractual documents to ensure completeness and accuracy; work with contracting staff to obtain missing or incomplete documents as needed • Work with national provider data service team to load newly contracted providers to the provider record database in a timely manner • Audit updated provider records to ensure the correct changes were made to the database; submit corrections as needed • Maintain the master repository of participating provider contracts, load newly executed provider agreements to the repository • Manage contracting team email box; appropriately respond and triage of both internal and external messages to the appropriate parties. Respond to emails within established turnaround times • Research and respond to inquiries from providers and internal staff regarding contractual matters such as a provider’s participating status in the Aetna Better Health of Illinois provider network • Send out provider welcome packets to newly contracted providers • Support internal contract auditing processes as requested • Compile, summarize and report on the Health Plan’s compliance with contract submission rules and exception requests, communicating on at minimum, a monthly basis • Assist with miscellaneous claims projects/audits and reviewing contracts and plan documents • Ensures compliance of health plan, corporate, state, and federal regulations • Escalate issues, as necessary, to management in a timely manner • Work with members of Network Development and internal department staff to identify process improvement opportunities • Perform other duties as assigned

🎯 Requirements

• 2-5 years of professional work experience, 1 year in the healthcare industry • Experience working in TriZetto QNXT • Experience with medical terminology • Experience working with Microsoft Office Suite • Proven ability to manage multiple workflows, prioritize effectively, and meet deadlines • Strong written and verbal communication skills, with the ability to convey complex information clearly

🏖️ Benefits

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