Job Description
Job Description
** Candidates must be within commutable distance to Miami Dade county **
Internally supports and contributes to positive provider relationships by handling routine provider service inquiries and problems regarding policies and procedures, plan design, credentialing process or status, and claims or compensation process or status.
- Supports the maintenance of contract or demographic
data.
- Triages routine provider issues and internal inquiries
regarding policies and procedures, credentialing or
claims status, orientation activities, and database or
portal information or usage.
- Escalates issues as appropriate.
- Supports or assists with operational activities that may
include, but are not limited to, database management
and contract coordination.
- Performs credentialing support activities as needed.
- Educates providers on portals, protocols, policies,
procedures, and services to enhance the overall provider
experience.
- May assist with or perform standard provider recruitment
or contracting or re-contracting functions and
discussions.
Required Qualifications
- Spanish Bilingual.
- Strong verbal and written communication and
interpersonal skills.
- Exposure to business segment specific policy, benefits,
plan and product design and language.
- Working knowledge of business segment specific codes,
products, and terminology.
- 1-3 years' related customer service experience
preferably with exposure to provider engagement.
- Associate's degree or 2 years of Provider Relations or
Network experience
Preferred Qualifications
Please see above.
Education
- Associate's degree or 2 years of Provider Relations or
Network experience
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.
** Candidates must be within commutable distance to Miami Dade county **
Internally supports and contributes to positive provider relationships by handling routine provider service inquiries and problems regarding policies and procedures, plan design, credentialing process or status, and claims or compensation process or status.
- Supports the maintenance of contract or demographic
data.
- Triages routine provider issues and internal inquiries
regarding policies and procedures, credentialing or
claims status, orientation activities, and database or
portal information or usage.
- Escalates issues as appropriate.
- Supports or assists with operational activities that may
include, but are not limited to, database management
and contract coordination.
- Performs credentialing support activities as needed.
- Educates providers on portals, protocols, policies,
procedures, and services to enhance the overall provider
experience.
- May assist with or perform standard provider recruitment
or contracting or re-contracting functions and
discussions.
Required Qualifications
- Spanish Bilingual.
- Strong verbal and written communication and
interpersonal skills.
- Exposure to business segment specific policy, benefits,
plan and product design and language.
- Working knowledge of business segment specific codes,
products, and terminology.
- 1-3 years' related customer service experience
preferably with exposure to provider engagement.
- Associate's degree or 2 years of Provider Relations or
Network experience
Preferred Qualifications
Please see above.
Education
- Associate's degree or 2 years of Provider Relations or
Network experience
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.
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