CVS Health Providership Coordinator in Redlands, California
Accountable for the accurate and timely provider number application and agreement process for Caremark and affiliates. Ensures the accuracy of information placed on file with state, federal and private payers on legally binding agreements. Works directly with payer, sales and managed care organization, the Caremark law department and Reimbursement. Ensures Division access to revenue for services rendered through proactive maintenance of provider status for all payer types.
·Accountable for all aspects of state and federal payer application process required to obtain appropriate provider status for the Caremark and affiliates, including initial research, tracking, follow-through and knowledge and interpretation of payer regulations and requirements relative to the issuance of provider status.
·Apply for and maintain provider numbers or maintain credentialing on a national level through the completion of legally binding documents and review of applicable regulations/payer standards for continuing provider status and issuance of numbers appropriate for payer designated provider classifications based on services rendered.
·Complete State and Federal Applications for provider status ensuring accurate and consistent disclosure of information in compliance with legal guidelines and payer requirements.
·Responsible for generating, proofreading and submission of agreements, completing RFP’s and disseminating results and requirements of executed agreements
·Prepares Payor designated applications necessary to obtain Provider Status for Caremark and affiliates as applicable. ·Monitors and ensures completion of annual or periodic Provider re-enrollment applications
·Maintains imaged copies of all Provider Enrollment /Re-enrollment applications via current imaging software
·Maintains Provider Agreement/Number Database, including specific obligations regarding State and Federal payer notification requirements for changes in Officers & Directors, Insurance, JCAHO accreditation, ownership & control etc. as well as maintaining a complete set of hard-copy files
·Accountable for notification to payors of changes in address, corporate officers, ownership & control etc. in accordance with specified timelines through regulation or payer specific guideline
·Completes payor specific information requests necessary to maintain current Provider information
·Assists in completion of State or Federal Requests for Proposal/Bids
·Resolves providership discrepancies through Payor contact and analysis of available information, notifying supervisor or manager when applicable
·Tracks incoming and outgoing applications/requests for information in a computerized format
·Ensures written payor notification of provider numbers is obtained and available for divisional use.
·Maintains computerized provider number database
·Maintains technical knowledge by attending educational seminars and in-service workshops.
·Maintains customer confidence and protects operations by keeping information confidential.
·Complies with the business principals, ethical standards, legal obligations and policy as outlined in Caremark’s Compliance and Ethics program.
·Contributes to team effort by accomplishing related results as needed.
3+ years of contract experience, paralegal, or related work experience
Demonstrated job history of 2+ consecutive years
1+ years of strong analytical skills and experience reviewing and interpreting payer regulations/guidelines
Customer service focus
LANGUAGE SKILLS: Strong written and verbal communication skills. Ability to communicate with all levels of internal and external personnel
MATHEMATICAL SKILLS: Ability to add, subtract, multiply, divide and calculate numbers, fractions, decimals, and percentages as required by day to day functions of the job.
REASONING ABILITY: Strong ability to identify and solve practical problems and deal with a variety of concrete variables in a standardized situation. Ability to interpret a variety of instructions and information furnished in written or oral format. OTHER SKILLS AND ABILITIES: Strong organization and inter-personal skills Computer skills
High school diploma or equivalent, some college preferable.
Coram CVS/specialty infusion services is a leading national provider of specialty home infusion and specialty pharmacy services. The integration of Coram into CVS Health enables the company to offer enhanced, comprehensive infusion services; expanded payer access; and a national network of more than 85 locations, including 65 ambulatory infusion suites. Providing infusion therapies and services to over 20,000 patients each month, Coram cares for patients through all phases of their healthcare continuum including clinical and compliance monitoring, and individual patient counseling. CVS Health, through our unmatched breadth of service offerings, is the nation’s largest pharmacy health care provider transforming the delivery of health care services in the U.S. Our energetic and service-oriented colleagues embrace fresh ideas, new perspectives, a diversity of experiences, and a dedication to service to meet the needs of the many people and businesses relying on us each day.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf and EEO IS THE LAW SUPPLEMENT at https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health at mailto:EEO_AA@CVSHealth.com
CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.
For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/