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.The Senior Coordinator, Providership will be accountable for the accurate and timely provider number application and agreement process for Caremark and affiliates. This role will perform all required tasks to enroll pharmacies in private, state, federal and third-party programs, as they relate to new store openings, acquisitions, pharmacy relocations, ongoing operations and ensure division access to revenue for services rendered through proactive maintenance of provider status. The Senior Coordinator will support the entire pharmacy network in all enrollments related matters to assure continuation of third-party agency participation in compliance with applicable state and federal regulations and payer guidelines. They will also act as liaison between pharmacy staff, third party agencies and internal departments to research and resolve issues relating to pharmacy enrollment.
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This role will be responsible for the accuracy of information placed on file with state, federal and private payers on legally binding agreements, the general preparation and distribution of all government applications pertaining to the assigned Pharmacy network and prepare documents pertinent to the government enrollment process. This position will apply and gather integral provider identifiers and national enumeration system from the National Enumeration System and National Council for Prescription Drug plan for proper and timely claim adjudication. This role will be accountable for all aspects of state and federal payer application process required to obtain appropriate provider status for Caremark and affiliates, including initial research, tracking, follow-through, knowledge and interpretation of payer regulations and requirements relative to the issuance of provider status. This role will monitor and ensure completion of period re-enrollment applications.
What you will do
- Apply for and maintain provider numbers or maintain credentialing on a national level through the completion of legally binding documents and review of applicable regulations/payer standards for continuing provider status and issuance of numbers appropriate for payer designated provider classifications based on services rendered.
- Complete State and Federal Applications for provider status ensuring accurate and consistent disclosure of information in compliance with legal guidelines and payer requirements.
- Ensure timely receipt of Medicare Part B
provider transaction access numbers and proper notification of such numbers to Third Party A/R. - Assist with or take the lead on contract research projects, tracking logs, contract files, and general support of the team with respect Medicaid enrollment requirements, including special projects, and corporate-wide initiatives.
- Communicate directly with governmental agencies as applicable during the application process and communicate any applicable deliverables to the respective operational areas.
- Accountable for timely payer notification according to regulatory requirements related to changes in Officers and Directors, ownership and control, Accreditation, etc.,
- Responsible for coordination and/or response to periodic required governmental surveys requiring detailed data related to dispensing or related costs, required to maintain ongoing provider status with the respective government payer
- 2+ years of prior related work experience
- 3+ years of experience in a contracting, paralegal, health care or pharmacy environment
- Must be able to work standard EST business hours
Bachelor's DegreeEducation
High School Diploma Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:$18.50 - $38.82This 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.