Job Description
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/aggregation & transferring of coding detail, images and operational reporting
Fundamental Components:
Responsible for providing guidance and direction to external vendors, external consultants, team members and/or matrixed staff as required to support Risk 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. 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.
Pay Range
The typical pay range for this role is:
Minimum: 43,700
Maximum: 97,400
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
Must have experience with IT application development lifecycles, methodologies.
Ability to influence others by turning data into meaningful and actionable information
Experience with SAS/SAS EG/SQL server in data analytics and manipulation
Attention to detail
Ability to document business processes, as well as, recommend and implement improvement strategies.
Ability to perform testing functions.
Participates in system design.
Ability to audit the accuracy of reports against source documents/reports/databases.
5 or more years of healthcare, health insurance, or relevant combination of experience
Strong problem-solving, analytical, critical thinking and project management skills.
Experience with CMS Risk Adjustment programs
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
Preferred Qualifications
see required qualifications
Education
Bachelor's degree in Mathematics, Economics, Statistics, Computer Science, Actuarial Science, Social Science, Healthcare or related discipline. or equivalent experience.
Business Overview
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.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.