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Network Relations Specialist

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Job Details
Job Order Number
JC168924614
Company Name
CVS Health
Physical Address

Overland Park, KS 66210
Job Description

Job Description

Internally supports and contributes to positive provider relationships by handling routine provider service inquiries and problems regarding policies and procedures, plan design, credentialing process or status, and claims or compensation process or status. Supports the maintenance of contract or demographic data.

Fundamental Components

+ Triage routine provider issues and internal inquiries regarding policies and procedures, credentialing or claims status, orientation activities, and database or portal information or usage. Escalates issues as appropriate.

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

+ Educates providers on portals, protocols, policies, procedures, and services to enhance the overall provider experience.

+ May assist with or perform standard provider recruitment or contracting or re-contracting functions and discussions.

Background Experience

+ 1-3 of Claims Processing experience or Provider relations experience

+ QNxt Experience is preferred

+ Strong verbal and written communication and interpersonal skills.

+ Exposure to business segment specific policy, benefits, plan and product design and language.

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

+ 1-3 years’ related customer service experience preferrably with exposure to benefits interpretation.

+ Associate’s degree or equivalent work experience.

Additional Job Information

QNXT Claims processing experience preferred.

Microsoft Excel experience preferred.

Education

High School diploma, G.E.D. or equivalent experience

Percent of Travel Required

0 – 10%

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.


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