About the position

At CVS Health, we are committed to bringing our heart to every moment of your health. This role is essential in maintaining the integrity of our Provider Data, which includes demographic and contractual information necessary for roster review configuration and loading. The individual in this position will ensure that all provider information is accurately recorded and maintained, which is crucial for proper reimbursement and member access, including directory listings. The responsibilities include developing and maintaining standards for database integrity, implementing corrective actions, and managing communication processes with other departments regarding database improvements. The role also involves providing support for baseline provider data transactions that cannot be administered automatically due to system limitations or data integrity issues. This includes performing demographic transaction updates in provider system applications to support claim adjudication and the Provider directory. Additionally, the position requires performing intake triage, responding to network inquiries, and escalating issues when necessary. Ongoing department support in research and analysis is essential for resolving concerns raised by providers and other internal or external customers. The individual will conduct audits of provider information and escalate issues for resolution as appropriate. They will also automate and manually load, maintain, and resolve all new and revised participating provider data transactions, which can range from basic to complex. Lastly, the role may involve loading third-party contracted reimbursement into applicable systems and extracting information from provider systems to meet business reporting needs.

Responsibilities • Maintain the Provider Data (demographic and contractual) for roster review configuration and loading. , • Ensure all provider information is accurately recorded and maintained for proper reimbursement and member access. , • Develop and maintain standards for database integrity and manage communication processes with other departments regarding database improvements. , • Provide support for baseline provider data transactions that cannot be administered automatically due to system limitations or data integrity issues. , • Perform baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory. , • Perform intake triage and respond to network inquiries, escalating when necessary. , • Provide ongoing department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers. , • Conduct audits of provider information and escalate issues for resolution as appropriate. , • Automate and manually load, maintain, and resolve all new and revised participating provider data transactions. , • Load third-party contracted reimbursement into applicable systems as needed. , • Extract information from provider systems to meet business reporting needs.

Requirements • 3+ years of experience and knowledge of Provider Data Services systems and other end user applications. , • 1-3 years' Network background. , • Advanced Microsoft Excel skills including knowledge of formulas and VLOOKUPs. , • 1+ years' QNXT experience. , • SQL experience.

Nice-to-haves • QuickBase experience , • Strong communication skills , • Strong critical thinking skills

Benefits • Full range of medical, dental, and vision benefits , • 401(k) retirement savings plan , • Employee Stock Purchase Plan , • Fully-paid term life insurance plan , • Short-term and long-term disability benefits , • Numerous well-being programs , • Education assistance , • Free development courses , • CVS store discount , • Discount programs with participating partners , • Paid Time Off (PTO) or vacation pay , • Paid holidays throughout the calendar year Apply Job!