At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary
Acts as the primary resource for assigned profile of larger and more complex providers (i.e. market/ regional/national, large physician group or
Hospital systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and
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procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.- Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency
targets.
- Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
- Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
- Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.
- Performs credentialing support activities as needed. Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
- Meets with key providers periodically to ensure service levels are meeting expectations.
- Manages the development of agenda, validates materials, and facilitates external provider meetings.
- Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed by business segment.
- May provide guidance and training to less experienced team membersRequired Qualifications
- 4 to 5 years of provider relations experience- servicing or managing non-standard relationships with providers with exposure to benefit plan design and/or contract interpretation.
- 3 to 5 years' experience with business segment specific policy, benefits, plan design and language.
- Working knowledge of business segment specific CPT and HCPC codes, products, and terminology.
- Proven advanced problem-solving skills, conflict management, an independent worker and self-starter.
- Ability to work remotely, in the Maine, Connecticut, Rhode Island, Massachusetts, New Hampshire and Vermont area.
- 2+ years of Medicare and Commercial insurance experience
- Ability to educate an outcome or position even if unfavorable.
- Ability to evaluate data and identify action plans or solutions based on data.
- Previous experience using EPDB and provider on-boarding tools
- Bachelor's Degree or equivalent combination of education and experience.
40Time Type
Full timePay Range
The typical pay range for this role is:$54,300.00 - $145,860.00This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.