Job Description
Job Description
Provides operational support and performs data maintenance and clean-up for data transactions (basic to complex). In addition, performs data transactions and maintenance associated with projects, expansions, and new product implementations. Works with other departments to ensure quality provider data to our members.
Required Qualifications
Demonstrated ability to handle multiple assignments.
Provider Data Services background (3-5 years).
Demonstrates Ability to facility meetings and make accurate records.
Maintains and updates provider demographic and contract information, including contractually sensitive or complex transactions, in appropriate systems in support of claims adjudication and provider directory.
Works collaboratively with internal/external constituents to implement new networks and complex contractual arrangements.
May provide technical and/or functional leadership within unit (i.e., team lead).
Performs validation of system enhancements.
Identifies, researches and conducts root cause analyses (e.g. problem providers identified by PST, trends from routine PDS audits) and collaborates cross-functionally within the organization to recommend process improvements.
Conducts and manages audits of provider information and escalates issues for resolution as appropriate.
Preferred Qualifications
Demonstrated ability to handle multiple assignments.
Provider Data Services background (3-5 years).
Demonstrates Ability to facility meetings and make accurate records.
Maintains and updates provider demographic and contract information, including contractually sensitive or complex transactions, in appropriate systems in support of claims adjudication and provider directory.
Works collaboratively with internal/external constituents to implement new networks and complex contractual arrangements.
May provide technical and/or functional leadership within unit (i.e., team lead).
Performs validation of system enhancements.
Identifies, researches and conducts root cause analyses (e.g. problem providers identified by PST, trends from routine PDS audits) and collaborates cross-functionally within the organization to recommend process improvements.
Conducts and manages audits of provider information and escalates issues for resolution as appropriate.
Education
Associate's degree or equivalent work 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.
Provides operational support and performs data maintenance and clean-up for data transactions (basic to complex). In addition, performs data transactions and maintenance associated with projects, expansions, and new product implementations. Works with other departments to ensure quality provider data to our members.
Required Qualifications
Demonstrated ability to handle multiple assignments.
Provider Data Services background (3-5 years).
Demonstrates Ability to facility meetings and make accurate records.
Maintains and updates provider demographic and contract information, including contractually sensitive or complex transactions, in appropriate systems in support of claims adjudication and provider directory.
Works collaboratively with internal/external constituents to implement new networks and complex contractual arrangements.
May provide technical and/or functional leadership within unit (i.e., team lead).
Performs validation of system enhancements.
Identifies, researches and conducts root cause analyses (e.g. problem providers identified by PST, trends from routine PDS audits) and collaborates cross-functionally within the organization to recommend process improvements.
Conducts and manages audits of provider information and escalates issues for resolution as appropriate.
Preferred Qualifications
Demonstrated ability to handle multiple assignments.
Provider Data Services background (3-5 years).
Demonstrates Ability to facility meetings and make accurate records.
Maintains and updates provider demographic and contract information, including contractually sensitive or complex transactions, in appropriate systems in support of claims adjudication and provider directory.
Works collaboratively with internal/external constituents to implement new networks and complex contractual arrangements.
May provide technical and/or functional leadership within unit (i.e., team lead).
Performs validation of system enhancements.
Identifies, researches and conducts root cause analyses (e.g. problem providers identified by PST, trends from routine PDS audits) and collaborates cross-functionally within the organization to recommend process improvements.
Conducts and manages audits of provider information and escalates issues for resolution as appropriate.
Education
Associate's degree or equivalent work 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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