Senior Analyst - Payer Relations

Job Description Drive operational excellence with pharmacy claims adjudication - Manage the day-to-day operations of claims adjudication initiatives and solutions in the pharmacy, and work effectively with internal and external stakeholders to drive meaningful improvements. This role is responsible for the diagnosis, ideation, testing, analysis, implementation of new and existing initiatives and solutions related to data optimization, reject mitigation, and margin retention Optimize the value-driving portfolio of adjudication services support the development and testing of business cases to determine the value and risks associated with expanding services or implementing new solutions/products. Be an advocate for our patients and Retail store colleagues, manage Help Desk escalations in a timely manner, diagnose and resolve tickets to promote medication adherence and customer satisfaction, and simplify the end-to-end billing process Support development of billing solutions that enable business growth/new healthcare services, working cross-functionally to prioritize, structure timelines, develop project plans, align stakeholders, and incorporate feedback in service of driving successful outcomes Support development of billing solutions that enable business growth/new healthcare services, working cross-functionally to prioritize, structure timelines, develop project plans, align stakeholders, and incorporate feedback in service of driving successful outcomes Support development of a near and longer-term adjudication technology strategic roadmap, taking inputs from multiple sources to influence internal and external stakeholders in the creation of novel solutions and programs which target emerging healthcare / billing opportunitiesPay RangeThe typical pay range for this role is:Minimum: 43,700Maximum: 97,400Please 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 3+ years of analytical experience within pharmacy, healthcare, managed care, or related field 2+ years of experience with pharmacy claims adjudication 2+ years of experience using advanced Excel, PowerPoint skills and other MS Office ApplicationsCOVID 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 Attention to detail, strong drive to ensure the integrity of underlying data and reports Ability to communicate and influence mid-level managers (Director and above), as demonstrated by 2+ years of experience creating and delivering leadership-facing materials and presentationsEducationBachelors Degree or equivalent job experienceBusiness 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: 2024-11-02