Provider Data Services Specialist (arizona) - Remote Eligible

Provider Data Services Specialist

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 Provider Data Services Specialist compares and contrasts the provider system with network data and regulatory sources, in order to ensure accuracy of data feeds to various applications. This person manages provider records to ensure the provider directory is accurate for members, as well as that records are set up appropriately for claims processing. This role involves working in a fast-paced environment with several colleagues serving various functions.

In this role, you will:

• Review and submit requests to update the provider module (within the QNXT system) for adds/changes related to Mercy Care Plan.
• Based on information from new contracts, expansion efforts, and routine provider changes, research the requests for updates to ensure they meet CMS (Centers for Medicare & Medicaid Services) and AHCCCS (Arizona Health Care Cost Containment System) regulations for member utilization.
• Utilize standard data elements for provider data to feed member directories, claim adjudication, encounter submissions, and regulatory utilization reports.

Required Qualifications

• 1-2 years of experience in customer service.
• Must reside in Arizona.

Preferred Qualifications

• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
• Strong analytical and written/oral communication skills.
• 1-2 years of experience with SQL.
• 1-2 years of experience in Microsoft Excel.
• Previous experience working with QNXT.
• Previous experience with medical claims processing.
• Previous knowledge of medical billing.

Education

• High school diploma or GED.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

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.