Bring 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.

Position Summary

As a Business Analyst within the Revenue Integrity COE organization, you will be supporting Risk Adjustment technical activities, not limited to electronic medical record data extraction, reconciliation and aggregation and operational reporting. This position also supports coordination across all shared services and vendors to assure data integrity and data validation processes are in place.To be successful, the candidate will use their knowledge and experience to create meaning from the data.

What you will do

• Responsible for providing guidance and direction to external vendors, external consultants, team members and/or matrixed staff as required to supportRisk Adjustment Revenue Integrity initiatives.

• Responsible for the reconciliation of data (coding review results and medical record images) from different sources, identifying gaps within the process, and developing more efficiency within the process.

• Actively participate in system design and be involved in testing new functions, as well as, the support of auditing activities.

• You will be responsible for auditing tasks including documenting and evaluating critical controls.

• You will be responsible for understanding procedures, results and business impacts; and document and express such understanding in both written and verbal form.

• Conducts periodic updates of analytical routines and department production systems. Investigates and evaluates alternative solutions to meeting business needs.

Required Qualifications

• 3+ years of healthcare, health insurance, or relevant combination of experience

• 3+ years of experience with SAS/SAS EG/Python/SQL server in data analytics and manipulation

• Must have experience with IT application development lifecycles, methodologies.

• Ability to perform testing functions

• Ability to audit the accuracy of reports against source documents/reports/databases.

• Experience in system design.

Preferred Qualifications

• Experience with CMS Risk Adjustment programs

• Ability to influence others by turning data into meaningful and actionable information

• Attention to detail

• Ability to document business processes, as well as, recommend and implement improvement strategies..

• Strong problem-solving, analytical, critical thinking and project management skills.

Education

Bachelor’s degree in Mathematics, Economics, Statistics, Computer Science, Actuarial Science, Social Science, Healthcare or related discipline. or equivalent experience.

Pay Range

The typical pay range for this role is:

$46,988.00 - $112,200.00

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.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 11/25/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.