Manager Project Management (IC)
CVS Pharmacy - Pittsburgh, PA
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Job DescriptionDynamic position within the Next Gen Provider Contract/Pricing team, responsible for ensuring accurate payment of provider contracts to Health Rules Payor (HRP). As part of the Contract and Pricing team, you will be responsible to research and respond to claims inquiries related to how the provider contract priced the claim. In addition, you would be involved in defining the business requirements in support of required pricing features and to configure provider contract provisions to support the many functions within the Next Gen business administrative platform, Health Rules Payor (HRP). Accurate provider pricing configuration is critical to claims adjudication, and ultimately, having satisfied consumers and providers. By working closely with other areas of the company such as network, product, claims, legal/compliance, medical policy, and/or segment leaders this position will be responsible to ensure the correct decisions are made when configuring contract and pricing features in this position you will be responsible to ensure Aetna's Next Gen provider contracts, rates, and pricing systems are configured to accurately process claims in adherence with provider contracts. You will interface directly with Medicare Service Operations, Network teams, HRP Provider Demographics, HRP Claims and HRP Product.Pay RangeThe typical pay range for this role is:Minimum: 60,300Maximum: 126,600Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications- Experience with SCM (Strategic Contract Manager) - EPDB (Enterprise Database) is required- Basic understanding of Provider Contracting is requiredPreferred Qualifications- Claims processing experience is desired.- Experience with Health Rules Payor is desired.- Proven track record in meeting project milestones andnegotiating for resources.- Proven communication skills both written and verbal.- Proven ability to affect change/interpersonal skills.Education4 year college degree or equivalent experience is desired.Business OverviewBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected 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.
Created: 2024-09-07