Manager, MEDICAL ECONOMICS

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

Serves as project manager and / or participant on selected project(s). Claim payment issues submitted through our MEU QuickBase tool will be reviewed in the claims and provider contracting systems for payment accuracy and if needed creating overpayment projects.

Provides claim processing, policy and contract set up expertise regarding payment accuracy to identify and correct Medical Cost drivers within the claim platforms.

Works cross-functionally throughout the region toward achieving operational targets. Collaborates through email, phone conversations and databases with other areas within CVS to resolve issues with system set up errors, contract errors and / or policy concerns.

Presents complex information in a way that multiple levels within an organization can understand and utilize to make appropriate decisions to meet business objectives.

Deliver findings to the project submitter through the QuickBase tool detailing outcome of research in plain language.

NOTE : THIS IS A HYBRID ROLE. Additional office location will be considered if not listed.

Required Qualifications

• HRP claim experience. Ability to pull claim data reports and analyze report.
• System knowledge Enterprise Provider Data Base(EPDB), STRATEGIC CONTRACTS INQ (SCM), RATE API Inquiry(SCSR), EWM - WORKFLOW MANAGEMENT (EWMP), Health Rules Payor(HRP), EXCEL;

QuickBase; Data Warehouse, ThoughtSpot

• Ability to interact with other business areas such as PIAB, Network, IT NOW, Medical Policy, MSO, and Claim and Call Policy.
• Be analytical through process and able to explain in detail your findings.
• HRP processing platform to review opportunities and understand how claims processed. Are the claims paying correctly, if not why how can it be avoided in the future?
• Claims / Policies & procedures
• Represent MEU on calls in correction opportunities
• Be analytical through process and able to explain in detail your findings.
• 5-8 years of relevant experience

Preferred Qualifications

• Strong analytic skills, skilled problem solver
• Ability to communicate effectively with all levels
• Ability to remain flexible with ever changing priorities
• Strong collaboration skills working across various teams
• Strong organizational skills
• Independent thinker
• Self-starter
• Ability to learn new technology
• Ability to manage conflicting priorities and multiple projects concurrently
• Demonstrates initiative, innovation and leadership in achieving results
• Demonstrates critical thinking and expresses ideas clearly, concisely and logically from a cross functional perspective

Education

Bachelor's or equivalent work experience

Pay Range

The typical pay range for this role is :

$60,300.00 - $152,600.00

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.