Description
We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience. At CVS Health, you'll be surrounded by colleagues who care deeply, innovate with purpose, and prioritize safety and quality in everything they do.
Job Summary: Acts as the primary resource for assigned, high-profile providers and/or groups to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims, or compensation issues, and provider education needs.
Key Responsibilities:
- 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 are resolved.
- Supports operational activities, such as database management and contract coordination.
- Performs credentialing support activities as needed.
- Educates Medicaid providers to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
- Meets with key providers at regular intervals to ensure service levels meet expectations.
- Manages the development of agenda, validates materials, and facilitates external provider meetings.
- Collaborates cross-functionally with the implementation of large provider systems to manage cost drivers and execute specific cost initiatives.
- May provide guidance and training to less experienced team members.
Requirements:
- A minimum of 5 years' work experience in healthcare.
- Minimum of 3 years' experience in Medicaid Managed Care business segment environment servicing providers with exposure to benefits and/or contract interpretation.
- Working knowledge of business segment-specific codes, products, and terminology.
- Travel within the defined territory up to 50-80% of the time.
- Must reside in the Dallas/Fort Worth Metroplex.
Preferred Qualifications:
- 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.
Education: Bachelor's degree preferred or a combination of professional work experience and education.
Salary Range: $60,300.00 - $132,600.00
Benefits: Eligible for a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.