, Illinois

Job Description
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.Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.Monitors service capabilities and collaborates cross-functionally 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.Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.Performs credentialing support activities as needed.Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.Meets with key providers periodically to ensure service levels are meeting expectations.Manages the development of agenda, validates materials, and facilitates external provider meetings.May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed by business segment.May provide guidance and training to less experienced team members.

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.Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.Working knowledge of business segment specific codes, products, and terminology.Bachelor’s Degree or equivalent combination of education and experience.

Preferred Qualifications
Please review required qualifications above

Education
Bachelor's degree or equivalent experience

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. See Job Description

, Illinois

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"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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