Network Relations Consultant

The Network Relations Consultant 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.

The Network Relations Consultant is responsible for the following:

• Conduct initial provider orientations as well as ongoing educational outreach.
• Conduct Provider Forums in conjunction with the team.
• Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface.
• Enhance account relationships by investigating, documenting, and resolving provider matters and effectively handling and responding to account changes and correspondence.
• Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance.
• Monitoring service capabilities and collaborating with cross-functional departments 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.
• Supporting and assisting with operational activities that may include, but are not limited to, database management, and contract coordination.
• SubmitUpdatestoDemographics or Roster modifications as needed for maintaining data integrity.
• Ensures compliance of health plan, corporate, state, and federal regulations during the course of business.
• Report to work on a consistent, regular basis during core business hours (8:00 am to 5:00pm).
• Provide responsive and professional customer service to both internal and external customers.
• Escalate issues, as necessary, to management in a timely manner.
• Meet or exceed established productivity standard of 10-12 provider visits a week.
• Conduct site visits when required.
• Additional Travel as needed.

• Candidates are to reside within the State of Ohio
• Minimum 3 years recent Healthcare Claims experience
• Excellent analytical and problem-solving skills
• Strong communication, and presentation skills
• Strong Microsoft Office Suite experience (Word, Excel, TEAMs)
• Must be able to travel, * Recent Managed Care Network experience in Provider Relations or Network Relations
• Behavioral Health experience
• Medicaid experience
• Strong Microsoft Word, and Excel experience preferred

Education

Associates degree or equivalent experience (HS diploma + 2 years relevant experience).

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.