Senior Negotiator

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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.

A Brief Overview

Controls programs to obtain the highest possible success rates and reductions on provider claims / bills to provide savings to both the client and the insured.

Negotiates OON medical claims at $12,500 and greater while also doing daily case assignments for the negotiation team, working up specialty client support items, and managing email inquiries as needed.

What you will do

• Assists with establishing and implementing results-based programs and innovative initiatives for the negotiation area, under general supervision.
• Applies in-depth knowledge of the negotiation field to offer feedback for decisions and innovation strategies that enhance organizational growth and visibility.
• Develops complex negotiation strategies and opportunities for potential savings for outpatient and professionals claims or bills valued at $2000 or less.
• Coordinates complex processes for incoming claims / bills to ensure client criteria are maintained (example : turnaround time) and established internal goals are met.
• Conducts routine investigation and resolution for issues surrounding pre- and post-negotiated claims / bills.
• Examines provider and claim history to assist in determining appropriate percentage reduction for negotiation based upon established guidelines for claims / bills $2,000 and under.
• Coaches more junior colleagues in techniques, processes, and responsibilities.

Checklist work up, outbound phone / fax / emails to negotiation, defensible documentation (70%)

Daily Assignments (5%)

Perform special client support items (10%)

• Reconciliations
• Settlements
• Installment Plans
• Single Case Agreements, pre-service and post-service
• Learns specialty pharmacy arrangements / dosing / long term agreements

20 successful cases / month with 30% capture rate

For this role you will need Minimum Requirements

• Working knowledge of execution and delivery (planning, delivering, and supporting) skills
• Working knowledge of business intelligence
• Working knowledge of problem solving and decision making skills
• Adept at collaboration and teamwork
• Adept at growth mindset (agility and developing yourself and others) skills
• 5-8 years in a medical claims environment with emphasis on edits, CMS standards, calculating accurate U&C, benchmarking medical costs, negotiating, setting up fee schedules, or a mixture of these attributes to support cost management

Education

Bachelor's degree preferred / specialized training / relevant professional qualification.

Pay Range

The typical pay range for this role is :

$43,700.00 - $107,200.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.

The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.

The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.

The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.

CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.

As for time off, Company employees enjoy Paid Time Off ( PTO ) or vacation pay, as well as paid holidays throughout the calendar year.

Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.