Network Relations Manager – Ltss
| Company | CVS Health |
|---|---|
| Location | Dunmore, PA, USA, Wilkes-Barre, PA, USA |
| Salary | $54300 – $132600 |
| Type | Full-Time |
| Degrees | |
| Experience Level | Mid Level, Senior |
Requirements
- 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.
Responsibilities
- Acts as the primary resource for assigned providers in a geographic location to establish, oversee, and maintain positive relationships by assisting with or responding to 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 inquiries, 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.
Preferred Qualifications
- Certified Billing and Coding Specialist (CBCS) preferred.