Senior Auditor (Provider Networks)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

As a key member of the Network team, this role leverages deep expertise in healthcare provider contracts, provider data, and network operations to support the development and maintenance of a high-performing regional provider network. The network is designed to meet or exceed standards for accessibility, compliance, quality, and financial performance.

The position collaborates cross-functionally to support negotiations for new and renewing provider agreements, serving as a subject matter expert on contract templates, documentation requirements, and contract management tools. Responsibilities also include conducting audits to support network expansion and contract maintenance, as well as initiating and supporting remediation efforts to ensure data and operational integrity.

What You Will Do

• Assist with establishing and implementing results-based programs and innovative initiatives for the network operations area, under general supervision.
• Collaborate internally and cross-functionally to support initial negotiations and re-negotiations of complex health care provider contracts.
• Utilize recruitment databases and contract management tools to design, build, load, audit, and edit complex contracts, agreements, amendments and fee schedules for physician/medical groups, IPAs, hospitals, and ancillary providers to support provider network maintenance and growth.
• Conduct research, analysis, and audits to proactively identify or promptly respond to contract-related complications and propose solutions to protect data, maintain contract integrity, enhance contract performance, and resolve provider concerns. Provide team with technical and other expertise for questions related to contract management system and the information contained therein.
• Coordinate and support contracting-related activities including pre- and post-signature contract reviews, accurate financial analysis, contract approvals, contract processing, and post-execution contract management.
• Apply knowledge of network operations to offer constructive feedback or suggest innovative operational approaches that enhance organizational performance, efficiency, and growth.
• Conducts comprehensive audits of provider applications and supporting documentation to ensure compliance with internal policies, regulatory standards, and contractual requirements.
• Identifies trends and root causes of recurring data quality issues through audit findings, and partners with relevant teams to implement corrective actions and process improvements.
• Maintains audit documentation and reporting in accordance with organizational standards, ensuring transparency, traceability, and readiness for internal or external review.
• Supports audit readiness efforts by developing and maintaining audit tools, checklists, and templates that promote consistency and accuracy across the Network Audit team.
• Collaborates with cross-functional teams (e.g., Credentialing, Contracting, Provider Relations) to resolve discrepancies and ensure timely remediation of audit findings.
• Utilizes data analytics tools (e.g., QuickBase, Excel, SharePoint) to track audit outcomes, monitor KPIs, and generate reports that inform leadership decisions.
• The ideal candidate will possess strong analytical and problem-solving skills, with the ability to work independently while maintaining clear and professional communication across teams.
• This role requires a high level of attention to detail, initiative, and the ability to navigate complex provider data and documentation.

Required Qualifications

• 3-5 years of experience working in managed healthcare contracting, network management, or supporting roles.
• QuickBase, Excel and SharePoint experience.
• Experience with multi-tasking and prioritizing duties.

Preferred Qualifications

• 3-5 years of experience with collaboration and cross-functional teamwork.
• 1-2 years of experience maximizing data accuracy.
• Working knowledge of medical claims and coding.

Education

Bachelor’s degree or equivalent experience (HS diploma + 4 years relevant experience)

Anticipated Weekly Hours