CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
Senior Network Relations Analyst
Location
Illinois
Posted
2 days ago
Salary
$47.0K - $112.2K / year
Seniority
Senior
Job Description
Senior Network Relations Analyst
CVS Health
• 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.
Job 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
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