Provider Data Service Senior Analyst

Company: CVS Health
Location: San Diego
Posted on: November 22, 2021

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 Previous Customer Service background experience Previous Claims processing experience Demonstrated ability to handle multiple assignments. 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. COVID Requirements COVID-19 Vaccination Requirement CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

• If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
• If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated. Preferred Qualifications Demonstrated ability to handle multiple assignments. Provider Data Services background (3-5 years). Demonstrates Ability to facility meetings and make accurate records. Utilizing Excel and spreadsheets to track date. Use of different databases. 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.

Keywords: CVS Health, San Diego , Provider Data Service Senior Analyst, Professions , San Diego, California