Medicaid Provider Data Services Specialist

Provider Data Management

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:

• Maintains the Provider Data (demographic and contractual) for all network and non-network providers.
• Ensures all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings).
• Develops and maintains standards for database integrity, corrective actions, database alignment, and manages communication processes with other departments regarding database improvements.
• Provides support for baseline provider data transactions that cannot be administered automatically through the provider database due to system limitations and/or data integrity issues.
• Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory.
• Performs intake triage and responds to network inquiries, escalates when necessary.
• Provides on-going department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.
• Conducts audits of provider information and escalates issues for resolution as appropriate.
• Automates and manually loads, maintains, and resolves all new and revised participating provider data transactions (basic to complex).
• May also load third party contracted reimbursement into applicable systems.

Required Qualifications:

• 1-3 years' of Medicaid claims experience.
• 1-3 years' Network background.

Preferred Qualifications:

• 1+ years' QNXT experience.
• Advanced Microsoft Excel skills including knowledge of formulas.
• Strong written and verbal communication skills.
• Demonstrated ability to handle multiple assignments.

Education:

• High school diploma or GED

Anticipated Weekly Hours 40

Time Type: Full time

Pay Range: $17.00 - $34.15

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:

• 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.