At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Responsible for helping to create and maintain a Network Database to track key financial contracting provisions such as Charge Master (CDM) increases, Fiscal Intermediary (FI) updates, etc… and helping network stay on top of requesting and processing this information annually.Responsible for auditing, building, and loading contract updates, agreements, amendments, and/or fee schedules in contract management systems per Aetna established policies.Track, submit and update the Charge Master and Fiscal Intermediary (FI )updates in Strategic Contract Manager (SCM) for Rural Health Centers (RHC) and Critical Access Hospitals (CAH)Help with SCM updates for demographic or provider tab updates onlyHelp with simple correction updates in SCMAssist with Late Load policy provisions as neededProvides network development, maintenance, and refinement activities and strategies in support of cross market network management unit.Research and report at team meetings on the Network Communications, Newsletter updates etc.Create and maintain a resource folder on the share drive with various information.Pull down the rates for Aetna Market Fee Schedules, Outpatient Groupers, Drugs, Medicare rates and file quarterly for network use.Collaborates cross-functionally to manage Hospital, Ancillary and provider submission of contractual information, and the review and analysis of audits.Help coordinate Business Intent Reviews requests with operationsPerform necessary SCM audit- correction audit, contract compareAssist with Pre-signature audit findingsEnsures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.Maintain the Rates Inquiry Tracking Tool (RITT) mailbox for both Kansas City and WichitaAssist with claims issues and settlement processes. Support health plan with expansion initiatives or other contracting activities as needed, such as Medicare and IFP Expansion/Access reporting.Help to monitor and respond to the onboarding tools      regarding provider requests for contractsSend out Non-Disclosure Agreements (NDA’s ) when contractor is working with a consultantMaintain Essential Community Provider (ECP) provider gaps for IFP and MedicareCoordinate the Network Selection Committee callPreparing reports and presenting to Network Management leadershipHelp track coding updates/process- DRG, HIPAAMaintain a full hospital listing with assignmentsMonitor the Credentialing Non-responder and notify contractor when outreach is needed

Required Qualifications

3+ years of experience working with ancillary providers, facilities, physician groups, and IPAs, including contract language, development and analysis of rate proposals, identifying operational and financial improvement opportunities, and collection and analysis of competitive data and key financial metrics. Understanding of common contract provisions, provider reimbursement methodologies and terms, and industry standard payment policies and practices.  Demonstrates high proficiency with Microsoft Office suite applications (e.g., Outlook, Word, Excel, etc.)Detail-oriented with strong communication, analytical and negotiation skills.Able to manage expectations and maintain strong relationships, both internally and externally.Ability to build collaborative relationships with providers and work cross-functionally to resolve complex provider contract issues.Highly organized and able to successfully manage and prioritize multiple projects, issues, and other tasks to ensure completion and meet deadlines.

Preferred Qualifications

Healthcare Industry experience with either a payer or providerStrong communication, critical thinking, problem resolution and interpersonal skills.Internal Aetna system knowledge a plus.Strong problem resolution and decision-making skills.

Education

Bachelor’s Degree or equivalent combination of education and professional work experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $132,600.00

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 06/13/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.