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Position Summary

Provider Engagement Specialist will be responsible for monitoring PR mailboxes which encompass provider claim inquiries, credentialing follow up, ERA submissions, W9 requests, contracting inquiries, etc. Assigning needed escalations to Provider Engagement Manager. Assist the health plan with provider outreach activities related, member access and availability, quality initiatives etc. Assist with escalated issues received from the Provider Call Center. Manage State portal, QuickBase requests and provider requests received via Availity portal. Schedule and coordinate JOC, conduct traditional provider webinars trainings. Outreach to providers to assure Access & Availability Survey compliance (outside of State vendor), as needed. Collaborate with network to assist in welcome packet distribution after contract execution, collect provider rosters, and validate for accuracy, coordinate with external Provider Engagement Manager, travel within Market, as requested, other Duties as assigned

• Provider Engagement Specialist (Internal PR Representative) (108)

• Monitoring PR mailboxes which encompass provider claim inquiries, credentialing follow up, ERA submissions, W9 requests, contracting inquiries, etc. Assign to Provider Engagement Manager .

• Assist the health plan with provider outreach activities related, member access and availability, etc.

• Issues received from the Provider Call Center.

• Manage State portal and QuickBase requests

• Status inquiries on requests and feedback to Health plan

• Schedule and coordinate JOC, webinars, etc.

• Access & Availability Survey monitoring (outside of State vendor), as needed

• Welcome packet distribution

• Collect provider rosters, coordinate with external Provider Engagement Manager

• Travel within Market, as requested

• Other Duties as assigned

Required Qualifications

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

• 3-5 years' experience with business segment specific policy, benefits, plan design and language

Preferred Qualifications

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

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

Education Bachelor’s Degree or equivalent combination of education and experience

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: 05/31/2024

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.