Network Relations, Senior Analyst
Job Summary
Acts as the primary liaison for assigned geography of integrated providers, establishing, overseeing, and maintaining provider risk management and positive relationships while supporting high-value initiative activities. Conducts provider education, ensures contract compliance, provider communication, claims research, and assists with resolution. Implements internal and external solutions to enhance provider satisfaction, meet cost targets, grow the network, and improve efficiency.
Required Qualifications
- Must be experienced in working with all reimbursement payment methodologies
- 3-5 years of provider relations and/or network management experience required
- Experienced in working with large provider groups, capitated agreements, and behavioral health providers
- Excellent written, oral, and interpersonal communication skills
- Computer literate in Word, Excel, Microsoft Office
- Must be flexible and able to handle a highly, fast-paced environment
- Must reside in North or South Carolina
Preferred Qualifications
- Knowledge of Medicare programs
- Knowledge of various Behavioral Health and Commercial payment methodologies
- Medical claims processing knowledge
- Experience working within Provider Databases (i.e. EPDB) a plus
- Critical thinking, problem resolution, and ability to work independently
- Excellent time management skills
Education
Associate Degree or equivalent combination of education and experience
Anticipated Weekly Hours
40
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.