Network Relations

o complex issues regarding Medicaid policies and procedures, service, claims or compensation issues, and provider education needs.

• Specialize in supporting Long-Term Services and Supports (LTSS) and Physical Health providers.
• Meets regularly, both in person and virtually, with assigned providers to conduct trainings and education, including required annual trainings, ensure understanding of Aetna policies and procedures, explain Aetna systems, etc.
• Serves as primary relationship manager with LTSS and HCBS providers and/or PH and BH providers to ensure positive provider experience with Aetna Better Health and promote network retention.
• Supports new assigned providers with onboarding, including orientation session(s).
• Responds to assigned provider questions or inquires, and if necessary, ensures prompt resolution to provider issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate education about participation in Aetna Better Health of PA plan.
• Convenes Joint Operating Committee meetings with providers, including organizing agendas, materials, and other growth partners (clinical, provider engagement), to discuss key operational, clinical, and quality related topics.
• Travel required within your assigned territory.
• Other duties as assigned.

Required Qualifications

• 3+ years' experience in Medicaid Managed Care business segment environment servicing providers with exposure to benefits and/or contract interpretation
• Experience working with LTSS providers.
• Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills
• Working knowledge of business segment specific codes, products, and terminology
• Must reside in the state of PA.

Preferred Qualifications

• Certified Billing and Coding Specialist (CBCS) preferred.

Education

• Bachelor's degree or equivalent professional work experience.

Pay Range

The typical pay range for this role is:$60,300.00 - $132,600.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 12/31/2024Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.