Payer Integrity Analyst
The Payer Integrity Analyst is responsible for implementation and managing all aspects of payer contracting processes.
Support the responsibilities, goals and objectives set forth by Payer Relations Contracting and Clinical Revenue Operations leadership.
Interact directly with the Regional Contract Directors, managers and colleagues from various teams including but not limited to AR, EPIC, AthenaHealth and other related IT teams to ensure integration of processes related to the successful implementation and management of the payer contracts.
1. Researching, documenting, maintaining and communicating payer contract details and requirements for implementation in various systems.
2. Serving as primary contact for assigned payer contracts and territories, supporting internal & external customers including Regional Directors, Contract Administration, Revenue Cycle Operations and other MinuteClinic teams as appropriate.
3. Maintaining payer fee schedules
4. Working with MinuteClinic operations in the implementation of new services
5. Supporting training new hires on the team and development of policies, procedures and workflows.
6. Proactively identifying and implementing efficiencies across the department including automation opportunities and workflow enhancement opportunities to reduce manual efforts.
7. Working with key stakeholders to develop training materials and standardize processes and drive efficiencies
8. Develop and effectively manage relationships with internal and external customers. The Analyst will interact and work with new and existing contracted payers across the country. In addition to the Clinical Operations teams and Payer Relations Regional Directors, the Analyst will interface and work with MinuteClinic administration, Third Party teams (Accounts Receivable, Billing, Call Center, Clinical Ops Teams, Compliance, Legal, Marketing, IT and MinuteClinic Field and Operations Management) to ensure seamless and effective integration of all processes.
2 or more years of working experience with insurance payers and contract implementation with a strong insurance payer knowledge and contract experience with national, regional, local payers in addition to third party administrators and PPO networks.
5+ years of working experience with insurance payers and contract implementation with a strong insurance payer knowledge and contract experience with national, regional, local payers in addition to third party administrators and PPO networks.
· Solid contract management and database system related experience.
· Solid project planning and management skills and the ability to participate on multiple cross-functional project teams to achieve on-time successful results.
· Excellent written and verbal skills including formal and effective presentation and ability to impact and influence peers, leaders and key stakeholders.
· Ability to understand data, analyze reporting and make sound recommendations and business decisions.
· Critical thinking and problem identification and solving skills along with the ability to manage and execute under pressure with competing priorities.
· Strong credibility, positive attitude and solid relationship management skills in interactions with internal and external customers.
· Proficient with Microsoft Office programs: Word, Excel, Outlook and PowerPoint.
· Ability to handle elevated and complex customer service complaints through to successful resolution.
· Analyze and report on metrics, identifying trends and opportunities.
· Maintain a professional, collaborative and positive work environment that promotes high performance.
· Act as a resource and subject matter expert.
High School Diploma/GED required. Bachelor’s degree in Healthcare Administration or Business is preferred.
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.