Risk Adjustment-Claims & Data Analytics

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Position Summary

The Purpose of the Manager, Business Consultation job is to monitor and manage day to day operations for Commercial Accountable Care Act (ACA) Prospective Programs.

The colleague in this role will work independently and has an opportunity to impact critical business operations. 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.

Required Qualifications

Assists 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 financial records, and manages department record retention.

Directs individuals to develop a high degree of customer service by fielding internal and external inquiries, finding resolutions, or redirecting as appropriate.

Confers internally and externally with clients and senior management regarding the organization's goals and objectives.

Coaches the internal and external department point of contact ensuring concise communication with employees, stakeholders, and members of the senior management.

Delivers advice to the organization regarding current business trends and best practices by preparing analyses for senior management, stakeholders, and clients.

Implements processes to performance appraisals within the business consulting department ensuring compliance and continuous improvement.

Helps establish and implement strategic review processes ensuring continuous improvement, compliance, and high-performance standards are upheld.

Preferred Qualifications

A minimum of 5 years expertise in Risk Adjustment payment models for Medicare Advantage, ACA and Medicaid.

Expertise in Risk Adjustment timelines and requirements

Prefer Colleague has some experience in query tools such as SQL, SAS, Python, R+

Certified Coding Certification such as CPC-P, CRC or AHIMA is preferred.

Education

Bachelor's Degree or equivalent combination of education and experience

Pay Range

The 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.