Senior Analyst, Network Relations

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 Senior Network Relations Analyst is responsible for the accurate and timely validation and maintenance of critical provider information and inquiries. Staff are 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. Staff may be responsible for reviewing claims data and information. The Senior Network Relations Analyst is responsible for monthly Access and Availability monitoring as required by state regulatory requirements. Staff ensure adherence to the business and system requirements of internal customers as it pertains to other provider network management areas.

• 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.
• Excellent written and verbal communication skills.
• Other duties as assigned.

• Deploy and support the Medicaid Provider Engagement program including onsite meetings at Aetna offices as required
• Reviews, learns and participates with operations teams regarding policy and procedures related to claims/providers.
• Assist with the monitoring of executed provider contracts to ensure Network Access meets State requirements
• Coordinates provider information with Provider Data Services including Member Services and other internal departments as requested as Provider Demographics are updated
• Supports providers by resolving problems and advising providers of new protocols, policies, and procedures
• Deliver training materials for staff and provider network. Participates as need for initial and ongoing provider in-services and provider education.
• Participates, when requested, in Grievance and Appeals meetings, and/or assists with tracking and trending provider grievances,
• Assists as requested for responses for all governmental, regulatory and quality assurance provider complaints; timely and continuous reconciliation of provider records; oversees Provider Access and Availability by reviewing Appointment Availability Audits conducted by staff
• Provides support and maintenance assistance for websites, portals, directories, manuals, and dashboards; plans, coordinates, and conducts provider forums and monthly webinars; develops communications including newsletters
• Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with member services and other internal department
• Promotes and educate providers on cultural competency

• A minimum of 2 years' work experience in healthcare.
• Experience in Medical Terminology, CPT, ICD-10 codes, etc.
• Experience working with the MS Office suite.

• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards.
• Experience in Medical Terminology, CPT, ICD-10 codes, etc.

• 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.