Network Relations Consultant

Columbus, OH, United States

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

The Network Relations Consultant acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. The Network Relations Consultant is responsible for the following:

Conduct initial provider orientations as well as ongoing educational outreach

Conduct Provider Forums in conjunction with the team.

Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface

Enhance account relationships by investigating, documenting, and resolving provider matters and effectively handling and responding to account changes and correspondence.

Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance

Monitoring service capabilities and collaborating with cross-functional departments to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved

Supporting and assisting with operational activities that may include, but are not limited to, database management, and contract coordination

Submit Updates to Demographics or Roster modifications as needed for maintaining data integrity

Ensures compliance of health plan, corporate, state, and federal regulations during the course of business

Report to work on a consistent, regular basis during core business hours (8:00 am to 5:00pm)

Provide responsive and professional customer service to both internal and external customers

Escalate issues, as necessary, to management in a timely manner

Meet or exceed established productivity standard of 10-12 provider visits a week.

Conduct site visits when required

Additional Travel as needed

Required Qualifications

Candidates are to reside within the State of Ohio

Minimum 3 years recent Managed Care Network experience in Provider Relations or Network Relations.

Excellent analytical and problem-solving skills

Strong communication, and presentation skills.

Preferred Qualifications Behavioral Health experince

Strong Microsoft Word, and Excel experience preferred Education Associates degree or equivalent work exeprince

Pay Range

The typical pay range for this role is:

$43,700.00 - $102,000.00

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. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 07/10/2024

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.