We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Network Configuration Specialist applies in-depth knowledge of contracting initiatives and data audits to enhance provider networks, while meeting and exceeding accessibility, compliance, quality, and financial goals. This person conducts routine review, design, and auditing for complex contract and network data, supports recruitment efforts, and collaborates on negotiations as needed.
Primary Responsibilities:
- Assists with establishing and implementing results-based programs and innovative initiatives for the network operations area, under general supervision.
- Applies in-depth knowledge of the network operations field to offer feedback for decisions and innovation strategies, in an effort to enhance organizational growth and visibility.
- Implements review, design, loading, and auditing of complex contracts, agreements, amendments, and/or fee schedules in contract management systems to enhance provider networks.
- Conducts routine research, analysis, and/or audits to identify issues and propose solutions to protect data, contract integrity, and performance.
- Provides technical expertise for questions regarding contracting and related systems and information contained.
- Coordinates complex contracting activities and implementation, as well as receipt and processing of contracts and documentation, in addition to pre-and post-signature review of contracts and language modification.
- Coaches more junior colleagues in techniques, processes, and responsibilities.
- Performs other duties as needed.
Required Qualifications
- 3-5 years of experience working with Medicaid and claims.
- Demonstrated computer literacy, with an ability to navigate through internal and external computer systems, including Microsoft Excel and SQL.
- Ability to work standard business hours from Monday-Friday, supporting Central Standard Time.
Preferred Qualifications
- Ability to effectively participate in a multi-disciplinary team including internal and external participants.
- Ability to use critical thinking skills to analyze claims, contracts, and state regulations for configuration.
- Strong customer service skills to coordinate service delivery, including attention to customers, sensitivity to issues, proactive identification, and resolution of issues, in order to promote positive outcomes for members and providers.
- Working knowledge of skills supporting execution and delivery (planning, delivering, and supporting).
- Working knowledge of business intelligence.
- Strong problem solving and decision-making skills.
- Ability to collaborate within a team, as well as interdepartmentally.
- Ability to self-motivate and drive own growth regularly.
- Bachelor’s degree or specialized training/certification.
Education
- High school diploma or GED.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$46,988.00 - $122,400.00This 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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 3-5 years of experience working with Medicaid and claims
- Demonstrated computer literacy, with an ability to navigate through internal and external computer systems, including Microsoft Excel and SQL
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
