Senior Analyst, Network Relations

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🔥 2 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $47k - $102k / year

⏰ Full Time

🟠 Senior

🛜 Network Engineer / Network Administrator

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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

• Investigate and resolve provider claim issues for timely and accurate adjudication • Submit demographic changes and updates to maintain accurate provider records • Handle PPO complaints, grievances and appeals, including contract generation and amendments • Manage provider network opt-in and opt-out participation requests • Facilitate credentialing requests and compliance with organizational and regulatory standards • Collaborate with the Department of Insurance and Special Investigations Unit on compliance and fraud prevention • Provide guidance and training to dental providers on policies, procedures and portal navigation • Send EFT, ERA and VCC enrollment requests for processing • Interact directly with dental providers and internal teams to support network participation, provider data accuracy, claims resolution, credentialing and contracting

🎯 Requirements

• Bachelor’s degree in dental, healthcare administration, business, or related field, or equivalent experience • 5+ years of experience in dental, provider relations, network management, or healthcare operations/administration • Strong understanding of PPO networks, credentialing processes and claims administration • Excellent communication and problem-solving skills • Proficiency in MS Office and provider management systems • Detail-oriented with strong organizational skills • Ability to manage multiple priorities in a fast-paced environment • Knowledge of regulatory requirements and compliance standards • Customer-focused commitment to service excellence • Preferred: experience in the dental field and knowledge of PPO and Medicare networks

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program eligibility