Senior. Analyst, Claims Operations (OhioRISE)
CVS Pharmacy - Columbus, OH
Apply NowJob Description
Job DescriptionAs part of the bold vision to deliver the "Next Generation" of managed care in Ohio Medicaid, Ohio RISE will help children and their families who are experiencing barriers achieve positive health outcomes and high quality of life indicators by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.This is a full-time teleworker position in Ohio. The Sr. Analyst, Claims Operations, services as a primary liaison to providers on claim related content and works with other departments to achieve resolution. This position identifies and analyzes user requirements, procedures, and problems to improve operational processes. Performs analysis on projects, identifies barriers and recommends potential business solutions to ensure successful implementation. Key contributor to overall project success. Fundamental Components: Serves as a primary liaison to providers on claim related content working with other departments for resolution Identify and analyze user requirements, procedures, and problems to improve existing operational processes Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations Identify ways to enhance performance management and operational reports related to operational processes Develop, share, and incorporate organizational best practices into business applications Diagnose problems and trends to identify opportunities for process redesign and improvement Formulate and update departmental policies and procedures Serve as the subject matter expert on the assigned function product to ensure operational performance. Consistently performs analysis and translates business needs to create high-quality Business Requirements and Functional Specifications documentation within specified time frames to solve most complex problems (multiple interfaces with other systems across multiple business units) considering all impacted components from an end-to-end perspective. Ensures end-to-end traceability of requirements is complete. Expert in one or more business systems. Applies specific functional and/or business expertise to perform assigned tasks and develop specific project deliverables. Conducts impact analysis of technology changes on business processes and existing technology. Competent to work at the highest technical capacity on most phases of the business systems analysis. Develops business workflow diagrams. Assists in the development of data models and interface design specifications Documents, tracks, and resolves issues related to provider experience. Creates appropriate communication materials are documented and distributed appropriately. Conducts interviews, fact-finding, and independent research to design creative, progressive operational solutions for business problemsRequired Qualifications 2+ years of experience in Account Management or management experience (Healthcare or Managed Care preferred) Strong knowledge of medical billing and claims processing required.COVID RequirementsCOVID-19 Vaccination RequirementCVS 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 Previous knowledge working in behavioral health. Managed care and/or Medicaid experienceEducation Bachelor's Degree in Health Care, Business, Finance, or any other field, or equivalent work experience in a related field.Business OverviewBring your heart to CVS HealthEvery 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.
Created: 2024-09-07