Provider Data Services, Analyst

Published date Posted on Indeed on Jan 06, 2022 (130 d ago)
  • Maintains the Provider Data (demographic and contractual) for all network and non-network providers.
  • Ensures all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings).
  • Develops and maintains standards for database integrity, corrective actions, database alignment, and manages communication processes with other departments regarding database improvements.

  • Provides support for baseline provider data transactions that cannot be administered automatically through the provider database due to system limitations and/or data integrity issues.

  • Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory
  • Performs intake triage and responds to network inquiries, escalates when necessary.
  • Provides on-going department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.
  • Sends requests to individual providers and/or delegated groups to verify information on file and follows up as needed to ensure information is received.
  • Conducts audits of provider information and escalates issues for resolution as appropriate.

Required Qualifications
  • Demonstrated PC skills, including Microsoft Office products and internet navigation skills.
  • Strong Excel skills a plus.
  • Previous industry experience or claims processing preferred.

COVID Requirements
CVS Health requires its Colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.

If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
  • Access, SQL, QuickBase experience

Education
High School Diploma or G.E.D.

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.


Let us know

Help us maintain the quality of jobs posted on RemoteTechJobs and let us know if:

Loading...
Success
Error on reporting

Related jobs

Company DescriptionSince we first opened our doors in 2009, the world of commerce has evolved immensely – and so has Square. After enabling anyone to take a payment and never miss a sale, we saw sellers stymied by disparate, outmoded products and tools.

General Dynamics Information Technology General Dynamics Information... |
|
Today

Travel Required: NonePublic Trust: OtherRequisition Type: RegularSummary:Develops, analyzes, and models operational, financial, and other organizational data to quantify the competitive performance of business segments, evaluate potential operational.

Dixon Hughes Goodman Dixon Hughes Goodman |
|
5 d ago

Responsibilities:Insurance enterprises across all sectors and lines of business face an evolving landscape of product, technology and corporate innovation. Delivering solutions requires a proactive and nimble approach. A career with DHG Insurance will.

BCD Travel Corporate BCD Travel Corporate |
|
6 d ago

Do you want to work in a fast-paced and exciting environment, where no two days are the same? We’re looking for a Developer, Orders Automation who enjoys both a buzz and a challenge?Developer, Orders AutomationFull-time, home based in the USWe’re BCD.

Piper Companies Piper Companies |
|
6 d ago

Piper Companies is looking for a Data Analyst, Pharmaceutical for a leading biopharmaceutical organization in the Philadelphia, PA area.THIS IS A REMOTE OPPORTUNITYResponsibilities for the Data Analyst, Pharmaceutical:You will drive pharmaceutical client.

Hivecell (www.hivecell.com) is a vibrant and innovative company focused on “edge as a service” technologies. From hardware to software, we’ve created a complete edge-as-a-service system that integrates wherever you need it and is designed to grow at.

TekWisen Software Pvt. TekWisen Software Pvt. |
Today

Job Description: EBS Technicalknowledge in Oracle EBS technical concepts and desired Functional know-hows.Modules PO, AP, AP, GL, FA, CM7+ years of Oracle EBS system implementation experience in an operations environment, with experience on requirements.

DescriptionSemarchy is looking for a technical pre-sales consultant to join our growing team. You should have a passion for working in the B2B enterprise data space, demonstrating, adapting and proving the value of data-based and integration technology.

Citrix builds the secure digital workspace technology that frees 400,000 customers to do their very best work from anywhere. By joining our award-winning workplace, you’ll be included in the globally diverse, collaborative team that values work-life.

DP Professionals DP Professionals |
Today

Seeking a Senior Business Systems Analyst for an opportunity in Columbia, SC. The BSA may sit remotely for this role.Summary:Defines customer needs in technical and business contexts.Ensure the proposed technical and business solutions meet the customer's.