Network Relations Consultant

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

The Network Relations Consultant acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.The Network Relations Consultant is responsible for the following:

• Conduct initial provider orientations as well as ongoing educational outreach.
• Conduct Provider Forums in conjunction with the team.
• Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface.
• Enhance account relationships by investigating, documenting, and resolving provider matters and effectively handling and responding to account changes and correspondence.
• Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance.
• Monitoring service capabilities and collaborating with cross-functional departments 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.
• Supporting and assisting with operational activities that may include, but are not limited to, database management, and contract coordination.
• Submit Updates to Demographics or Roster modifications as needed for maintaining data integrity.
• Ensures compliance of health plan, corporate, state, and federal regulations during the course of business.
• Report to work on a consistent, regular basis during core business hours (8:00 am to 5:00pm).
• Provide responsive and professional customer service to both internal and external customers.
• Escalate issues, as necessary, to management in a timely manner.
• Meet or exceed established productivity standard of 10-12 provider visits a week.
• Conduct site visits when required.
• Additional Travel as needed.

• Candidates are to reside within the State of Ohio
• Minimum 3 years recent Healthcare Claims experience
• Excellent analytical and problem-solving skills
• Strong communication, and presentation skills
• Strong Microsoft Office Suite experience (Word, Excel, TEAMs)
• Must be able to travel

• Recent Managed Care Network experience in Provider Relations or Network Relations
• Behavioral Health experience
• Medicaid experience
• Strong Microsoft Word, and Excel experience preferred

• 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.