CVS Health hiring Risk Adjustment-Claims & Data Analytics in Tallahassee, Florida, United States | LinkedIn (2024)

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 SummaryOur team is growing and seeking an Analyst to support and manage day to day operations for Commercial Accountable Care Act (ACA) Prospective Programs.

This role can be remote if there is not a hub nearby.The colleague in this role will work independently and has an opportunity to impact critical business operations. You will work with the ACA Commercial Stakeholders, ensure timely reconciliation of claims for encounter submission deadlines, while also meeting the needs of Revenue Integrity’s internal market and product customers. You will also assist in managing the day-to-day complex business consultation services to support the organization's goals and objectives.

• Implements processes and assignments for research, collecting, analyzing, and compiling data and information for the business consulting department reports.
• Assesses files, reports, and manages department record retention.
• Helps establish and implement strategic claim review processes ensuring continuous improvement, compliance, and high-performance standards are upheld.

Required Qualifications

• 3+ years of experience in Risk Adjustment payment models for Medicare Advantage, ACA or Medicaid.
• 1+ years of experience using SQL to wrangle data out of disparate data sources.
• 1+ years of experience working directly with cross functional teams and/or stakeholders

Preferred Qualifications

• 5+ years of experience in Risk Adjustment payment models for Medicare Advantage, ACA and Medicaid.
• Expertise in Risk Adjustment timelines and requirements
• SAS, Python, R+ are preferred, 3+ years of experience using SQL for reconciliation
• Certified Coding Certification such as CPC-P, CRC or AHIMA is preferred.

EducationBachelor's Degree or equivalent combination of education and experience

Pay RangeThe typical pay range for this role is:

$54,300.00 - $119,300.00

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 jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 08/15/2024

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