Senior Analyst, Network Relations

Sacramento, CA, 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:Serves as local market contract management software expert. Local Market resource who creates, maintains, and loads provider contracts into contract management software and submits requests in Quickbse for Medical Economics analysis in support of Network directors. Maintains excellent working relationships internally; works collaboratively with internal facing departments.

Understanding of claims and provider contracts, particularly complex hospital contracts and reimbursement methods.

Acts as the primary resource for IPA and Hospital provider contracts (i.e., market/ regional/national, large delegated groups or hospital systems) to establish, oversee, and maintain provider contracts in SCM and support provider contract related activities. Serves as local market SCM expert. Works with teams on initiatives impacting provider contracts, provider satisfaction, network growth, and efficiency. Local Market resource who creates, maintains, and loads provider contracts in SCM and submits requests in QB for MEU analysis in support of Network Managers. Maintains excellent working relationships internally; works collaboratively with CCU, PDS, Delegation, Claims, capitation, BIR, MEU, and NRMs. Internal facing only.

Understanding of claims and provider contracts, particularly complex hospital contracts and reimbursement method

Required Qualifications

3+ years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation.

Preferred Qualifications

-Working knowledge of business segment specific codes, products, and terminology.

-3-5 years' experience with business segment specific policy and provider contracts.

-Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.

-Experience using various systems and comfortable using complex applications for provider contract entry.

-Curious self starter who enjoys research.

-Optimizes interactions with internal business partners to establish and maintain productive, professional relationships.

-Collaborates cross functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.

-Supports or assists with activities that may include, but are not limited to, database management, and contract coordination.

-May collaborate cross-functionally on the implementation of contracts or provider demographic updates.

Microsoft Excel fluency is a must.

EducationBachelors degree and/or healthcare experience equivalent.

Pay Range

The typical pay range for this role is:

$43,700.00 - $107,200.00

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: 06/20/2024

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.

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