Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
Applies in-depth knowledge of contracting initiatives and data audits to enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals. Conducts routine review, design and auditing for complex contract and network data as needed.
- Assists with establishing and implementing results-based programs and innovative initiatives for the network operations area, under general supervision.
- Applies in-depth knowledge of the network operations field to offer feedback for decisions and innovation strategies that enhance organizational growth and visibility.
- Implements review, design, loading, and auditing of complex contracts, agreements, amendments and/or fee schedules in contract management systems to enhance provider networks.
- Conducts routine research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance. Provides technical expertise for questions related to contracting and related systems and information contained.
- Coordinates complex contracting activities, implementation, coordinate receipt and processing of contracts and documentation and pre-and post-signature review of contracts and language modification.
- Coaches more junior colleagues in techniques, processes, and responsibilities.
Required Qualifications
- 3-5 years of Medicaid work experience
- 3-5 years of experience performing complex audits of claims adjudication and/or pricing.
- Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.
Preferred Qualifications
- Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members and providers.
- Ability to effectively participate in a multi-disciplinary team including internal and external participants.
- General Business – Ability to use critical thinking skills to analyze claims, contracts, and state regulations for configuration.
- Adept at collaboration and teamwork
- Adept at growth mindset (agility and developing yourself and others) skills
- Working knowledge of execution and delivery (planning, delivering, and supporting) skills
- Working knowledge of business intelligence
- Working knowledge of problem solving and decision making skills
Education
- Bachelor’s degree preferred/specialized training/relevant professional qualification or equivalent experience.
Pay Range
The typical pay range for this role is:
$43,700.00 – $105,100.00
This 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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.