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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:
Our team is growing with the business needs! As a Senior Informatics Developer within the Revenue Integrity organization, you will be leading Risk Adjustment technical activities, not limited to electronic medical record data extraction, reconciliation and aggregation, and financial and operational reporting.

Overview:

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

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

• Act as business lead for system design and in testing new functions, as well as the support of auditing activities related to vendor reconciliation of coding results and medical record images as well as other technical projects. 

• Drive change related to enhancements and system fixes.  Understanding interdependencies in both process and timing to further business objectives.  To be successful, the candidate will use their knowledge and experience to create meaning from the data.

• This position also supports coordination across all shared services and vendors to assure data integrity and data validation processes are in place.  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. 

• Support 1m IFP members through tightly managing vendor data quality and timeliness; ensure data is ingested into CREW to drive submissions; any and all CREW validation errors are worked timely to ensure submission completeness; analyze and understand digital retrieval to maximize results; customize ACA reporting views and outreach manager data needed for day to day operations work.

Required Qualifications:

• 3+ years of experience in reporting and data analytics/informatics in a healthcare, Health insurance or similarly regulated environment

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

• 3+ years of experience with BI tools, including Tableau, Quicksight, PowerBI.

Preferred Qualifications:

• 5+ years of experience in reporting and data analytics/informatics in a healthcare, Health insurance or similarly regulated environment

• Vendor management experience.

• Experience with CMS Risk Adjustment programs.

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

• 5+ years of experience with several of the following methodologies: management consulting, project consulting, business process consulting, financial strategic analysis strategic business planning, and/or risk management consulting.

• Experience documenting business processes, as well as, recommending and implementing improvement strategies. 

• Participates in system design.

• Experience with IT application development lifecycles, methodologies.

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

• Experience influencing others by turning data into meaningful and actionable information.

• Ability to perform testing functions.

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

• Ability to implement auditing procedures.

• Attention to detail.

• Strong negotiation skills.

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Education

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

Pay Range

The typical pay range for this role is:

$66,330.00 - $145,860.00

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: 09/30/2024

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