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CVS Health · 1 month ago

Project Manager, Provider Network Contract Validation, Remote

United States

Full-time

Remote

Mid Level

$54K/yr - $159K/yr

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care. The Project Manager will be responsible for ensuring accurate payment of provider contracts through the Health Rules Payor platform, reviewing and auditing contract setups, and coordinating corrections as necessary.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

Responsible for ensuring accurate payment of provider contracts through Health Rules Payor (HRP) a claims processing platform

Responsible for reviewing, auditing, and coordinating the correction (if necessary) of HRP contract setup against contract intent and evaluate the pricing performance of claims

Work closely with other areas of the company such as Network, Provider Data Services, Next Gen Provider Contract/Pricing team, Business Intent Review (BIR), HRP Provider Demographics, HRP Claims, HRP Product, legal/compliance, medical policy, and/or segment leaders

Responsible for ensuring the correct decisions were made when configuring contract and pricing features in HRP prior to contract implementation

Participate with workgroups for process improvement

Qualification

Health Rules PayorSCMEPDBProject ManagementProvider ContractingExcelClaims processingData interpretationCommunication skillsInterpersonal skillsOrganization skillsTime managementProblem solving

Required

Experience with SCM (Strategic Contract Manager) and/or EPDB (Enterprise Provider Database), and/or HRP (Health Rules Payor) or similar systems is required

Project Management

Basic understanding of Provider Contracting is required

Experience with EXCEL and working with large data files is critical

Preferred

Claims processing experience is desired

Experience with Health Rules Payor is desired

Proven track record in meeting project milestones and negotiating for resources

Proven communication skills both written and verbal

Proven ability to affect change/interpersonal skills

Knowledge of Aetna's Commercial and Medicare products

Strong organization skills & time management

Able to independently resolve problems

Ability to handle multiple assignments accurately and efficiently

Able to interpret data, translate it into meaningful information and draw conclusions

Benefits

Affordable medical plan options

401(k) plan (including matching company contributions)

Employee stock purchase plan

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility