Provider Data Services Specialist

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Provider Data Specialist compare and contrast the provider system with network data and regulatory sources to ensure data feeds to various applications are accurate. The Provider Data Analyst manages our provider records to ensure the provider directory is accurate for our members, and that records are set up appropriately for claims processing.

Review and submit requests to update the provider module within the QNXT system for adds/changes related to Mercy Care Plan.

This is a fast paced environment with great team diversity.

Based on information from new contracts, expansion efforts, and routine provider changes, research the requests for updates to ensure they meet CMS and AHCCCS regulations for member utilization.

Standard data elements for provider data is used to feed member directories, claim adjudication, encounter submissions, and regulatory utilization reports.

Required Qualifications

Demonstrated ability to handle multiple assignments competently, accurately and efficiently.

Strong analytical and written/oral communication skills.

1-2 years of customer service experience.

Preferred Qualifications

MS SQL Experience – Basic (1-2 Years).

Excel Experience – Intermediate (1-2 Years).

Hands on experience working with QNXT.

Medical Claims Processing.

Medical Billing Knowledge.

Education

High School Diploma or GED

Pay Range

The typical pay range for this role is:

$17.00 – $25.65

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 Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 10/15/2024

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

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.