Medicaid Provider Operations Support - Provider Data Services (remote) - Remote Eligible

Medicaid Provider Operations Support

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 Medicaid Provider Operations Support (MPOS) team will serve as the primary Point of Contact (POC) for the Provider Data Services (PDS) team as they work on data cleanup reports across multiple Health Plans (HPs) within the Medicaid regions. All communications will be coordinated through the designated Liaisons for each scope within MPOS.

Expectations of Medicaid Provider Operations Support:

• Provides guidance to all analysts on issue resolution and accurate provider data setup, in alignment with established standards and Health Plan-specific requirements.
• Collaborate with team members to identify, review, and research issues in support of effective solutions.
• Support the review and potential revision of documentation based on new guidance provided by the Liaison.
• Supports the identification and resolution of internal performance issues, as well as team development opportunities.
• Enhances the health plan's confidence through reliable partnership and consistent engagement.
• Reduces turnaround time for issue resolution by minimizing dependency on Health Plan responses.
• Minimizes repeated outreach to the health plan through proactive issue resolution and knowledge sharing.
• Minimizes impact on overall productivity.
• Manage team production workflows to ensure timely and accurate case completion.

Liaisons will handle and support the following:

• Attending all regularly scheduled meetings as assigned.
• Reviewing escalated requests, ensuring timely issue resolution, and communicating outcomes, while prioritizing issues as needed.
• Supporting and maintaining Health Plan Data Sheets by reviewing and updating them to reflect accurate information as new standards are implemented.
• Serving as the Subject Matter Expert (SME) and Point of Contact (POC) for provider data clean-up across all Medicaid states.
• Identify and escalate significant trends or concerns within designated areas to MPOS leadership.
• Assigning data clean up tasks to analysts based on reports from various states.
• Responding daily to inquiries and emails related to provider data across multiple health plans.

Required Qualifications:

• Minimum of 1 year of experience in provider data management.
• Minimum of 1 year of direct communication experience with internal teams and external partners.
• Proficiency in managing provider data, supporting operations, and navigating network structures.
• Proficient in Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook.
• Extensive knowledge of problem-solving methodologies and effective troubleshooting strategies.

Preferred Qualifications:

• SQL experience.
• QuickBase experience.
• QNXT system knowledge.
• Excel Skills: (VLOOKUPS and Pivot Tables)

Education:

• Bachelor's degree or equivalent experience with a High School Diploma.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range:

The typical pay range for this role is: $18.50 - $35.29

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.

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 people:

We 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.

We anticipate the application window for this opening will close on: 11/01/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.