Provider Data Services Specialist

At reputed company, we?re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation?s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues ? caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary ? Maintains the Provider Data (demographic and contractual) for reputed company network and non-network providers. ? Ensures reputed company provider information is accurately recorded and maintained to reputed company for proper reimbursement and member reputed company (i.e., directory listings). ? Develops and maintains standards for database reputed company, corrective actions, database alignment, and manages communication processes with other departments regarding database improvements. ? Provides support for baseline provider data transactions that cannot be administered automatically through the provider database due to system limitations and/or data reputed company issues. ? Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory. ? Performs intake triage and responds to network inquiries, escalates reputed company necessary. ? Provides on-going department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers. ? Conducts audits of provider information and escalates issues for resolution as appropriate. ? Automates and manually loads, maintains, and resolves reputed company new and revised participating provider data transactions (basic to reputed company). ? May also load reputed company party contracted reimbursement into applicable systems. Required Qualifications ? 1-3 years' of reputed company claims experience. ? 1-3 years' Network background. Preferred Qualifications ? 1+ years' QNXT experience. ? Advanced reputed company reputed company skills including knowledge of formulas. ? Strong written and verbal communication skills. ? Demonstrated ability to handle multiple assignments. Education ? High school diploma or GED Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $17.00 - $34.15 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in our comprehensive and competitive mix of pay and benefits ? investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include: ? Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. ? No-cost programs for reputed company 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 reputed company and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 05/07/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!