CVS Health is building a world of health around every consumer. We are looking for a Medicaid Provider Operations Support professional to join our team. In this role, you will serve as the primary Point of Contact for the Provider Data Services (PDS) team, coordinating provider data cleanup reports across multiple Medicaid Health Plans. You'll be a key liaison ensuring accurate provider data setup and resolution of issues.
What You'll Do
- Provide guidance to analysts on issue resolution and accurate provider data setup.
- Collaborate with team members to identify, review, and research issues.
- Support review and potential revision of documentation based on new guidance.
- Identify and resolve internal performance issues and team development opportunities.
- Enhance health plan confidence through reliable partnership and consistent engagement.
- Reduce turnaround time for issue resolution by minimizing dependency on Health Plan responses.
- Minimize repeated outreach to health plans through proactive resolution and knowledge sharing.
- Manage team production workflows to ensure timely and accurate case completion.
- Attend all regularly scheduled meetings as assigned.
- Review escalated requests, ensure timely issue resolution, and communicate outcomes.
- Support and maintain Health Plan Data Sheets by reviewing and updating them.
- Serve as the Subject Matter Expert and Point of Contact for provider data clean-up across all Medicaid states.
- Identify and escalate significant trends or concerns to MPOS leadership.
- Assign data clean up tasks to analysts based on reports from various states.
- Respond daily to inquiries and emails related to provider data across multiple health plans.
What We're Looking For
- Minimum of 1 year of experience in provider data management.
- Minimum of 1 year of direct communication experience with internal teams and external partners.
- Proficiency in managing provider data, supporting operations, and navigating network structures.
- Proficient in the Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook.
- Extensive knowledge of problem-solving methodologies and effective troubleshooting strategies.
Nice to Have
- SQL experience.
- QuickBase experience.
- QNXT system knowledge.
- Advanced Excel skills including VLOOKUPs and Pivot Tables.
Technical Stack
- Microsoft Office Suite
- Excel
- SQL
- QuickBase
- QNXT
Team & Environment
You will be a member of the Medicaid Provider Operations Support (MPOS) team, serving as a Liaison for the Provider Data Services (PDS) team. You will report to MPOS leadership.
Benefits & Compensation
- Compensation: $18.50 - $35.29 per hour
- Affordable medical plan options.
- 401(k) plan with matching company contributions.
- Employee stock purchase plan.
- No-cost programs including wellness screenings, tobacco cessation, weight management, confidential counseling, and financial coaching.
- Paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access.
Work Mode
This is a fully remote position.
CVS Health is an equal opportunity employer. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
