Provider Data Services Senior Coordinator (Fully Remote)
About the position
As a Provider Data Services Senior Coordinator at CVS Health, you will play a crucial role in maintaining the integrity of provider data, which includes demographic and contractual information. This position is fully remote and requires a commitment to ensuring that all provider information is accurately recorded and maintained. Your work will directly impact proper reimbursement processes and member access, particularly through directory listings. You will be responsible for developing and maintaining standards for database integrity, implementing corrective actions, and managing communication processes with other departments to enhance database improvements. In this role, you will provide support for baseline provider data transactions that cannot be processed 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. You will also handle intake triage, respond to network inquiries, and escalate issues when necessary. Ongoing support in research and analysis will be essential for resolving concerns raised by providers and other internal or external customers. Additionally, you will conduct audits of provider information, automate and manually load new and revised participating provider data transactions, and may also load third-party contracted reimbursement into applicable systems. Extracting information from provider systems to meet business reporting needs will also be part of your responsibilities, ensuring that the data is accurate and up-to-date.
Responsibilities
Maintain the Provider Data (demographic and contractual) for roster review configuration and loading.
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Ensure all provider information is accurately recorded and maintained for proper reimbursement and member access.
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Develop and maintain standards for database integrity and manage communication processes with other departments regarding database improvements.
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Provide support for baseline provider data transactions that cannot be administered automatically due to system limitations or data integrity issues.
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Perform baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory.
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Perform intake triage and respond to network inquiries, escalating when necessary.
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Provide ongoing department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.
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Conduct audits of provider information and escalate issues for resolution as appropriate.
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Automate and manually load, maintain, and resolve all new and revised participating provider data transactions.
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Load third-party contracted reimbursement into applicable systems as needed.
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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.
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1-3 years' Network background.
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Advanced Microsoft Excel skills including knowledge of formulas and VLOOKUPs.
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1+ years' QNXT experience.
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SQL experience.
Nice-to-haves
QuickBase experience
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Strong communication skills
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Strong critical thinking skills
Benefits
Full range of medical, dental, and vision benefits
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401(k) retirement savings plan
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Employee Stock Purchase Plan
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Fully-paid term life insurance plan
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Short-term and long-term disability benefits
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Numerous well-being programs
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Education assistance
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Free development courses
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CVS store discount
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Discount programs with participating partners
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Paid Time Off (PTO) or vacation pay
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Paid holidays throughout the calendar year
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