At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary
As a member of the Network Performance team, you will be responsible for assessing current portfolio of products, connecting to standard adjudication services, with focus on performance, reliability, and parity. Identify and create custom solutions to support and meet on going business needs. Provide comprehensive reporting and key performance metrics for reconciliation, revenue cycle, and adjudication/claims processes analysis. Facilitate effective solutions related to adjudication and processing of pharmacy and vaccine/medical claims, maintaining current services, support optimalization of existing vendor product portfolio, provide continual evaluation of processes and procedures to assist in new product development, create business cases from data driven strategic decision making to identify revenue risk and new revenue opportunities.
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Assist in building, testing/deploying solutions and updates to relevant solutions, complete within specified timelines and monitor performance, outcomes and reporting to ensure proper functionality and de-collisioning when needed. The Sr Anlayst will work cross functionally with both internal and external partners to inform, influence, and support design solutions, technology, tools and processes that simplify billing of products/services, remove friction from the system, thereby enabling access to care for our patients, simplifying process for our colleagues and delivering value to the enterprise.The position requires strong analytical skills, communication, collaboration and be a subject matter expert to be able to guide and influence internal and external business partners. This role will also be responsible for review and resolution for incidents reported through the Store Support center related to claim transactions, initiatives, and to support our store colleagues.
The Retail Adjudication Products Sr Analyst will work cross functionally with both and external partners to inform, influence, and recommend solutions, tools and processes that simplify of products/services to remove friction from the system, whereby enabling access to care for our patients, simplifying processes for our colleagues and delivering value to the enterprise.Strategic Planning
• Assist in all phases of new product/or product enhancements, ranging from creating initial business cases through launching solutions to our colleagues and customers.
• Drive operation excellence for pharmacy/medical billing working with internal and external stakeholders, program development, testing, implementation/deployment to launch solutions to our customers and colleagues.
• Facilitates the creation of field facing materials with cross-functional Communications partnership for key touchpoints.
• Partner with Senior Manager to communicate plans, risks, and opportunities from working team up to leadership.
• Supports the Senior Manager in developing an effective communication strategy for alerting both internal and external leaders of anticipated changes, partnering with communication teams as needed
• Create near and longer-term adjudication technology strategy
Delivers Results
• Optimize value driving portfolio of adjudication services, using solid business cases that determine the risk and value with expanding services or implementing new solutions/products.
• Continually evaluates product performance against KPIs and identify opportunities for improvement to Senior Manager based on performance
• Perform data analysis on new/existing solution to discover new opportunities and monitor key processes for implemented solutions.
• Optimizes and level sets expectations with stakeholders by partnering closely with Store Operations leaders, Retail Field Leadership, IT, digital and our portfolio managers to ensure appropriate levels of support and collaboration
• Work cross-functionally with CSC partners to develop strategies and action plans to mitigate identified risks and opportunities tailored to the specific needs of pharmacy business unit, as needed.
• Development of billing/vendor 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
Stakeholder Influence and Change Management
• Collaborates with cross-functional teams, including IT, digital teams, pharmacy operation teams, and other stakeholders to deliver high-impact solutions
• Leverages data, insights, and analytics to influence stakeholders and makes recommendations as appropriate
• Be an advocate for our patients and Retail store colleagues, identifying opportunities to reduce patient out-of-pocket expenditure at no cost to the enterprise, promote medication adherence and customer satisfaction
Ad-Hoc Analysis
• Supports our pharmacy teams and core business partners utilizing reporting and analysis
• Adapt reporting to inform strategies to identify trends communicating those to the right partners as needed.
• Translates data insights into meaningful insights and actionsRequired Qualifications
- 2+ years of experience with pharmacy claims adjudication and NCPDP standards
- 3+ years of analytical experience within pharmacy, healthcare, managed care, or related field
- 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 presentations
- Proven ability to collaborate with internal and external partners
- 2+ years of experience using advanced Excel, PowerPoint skills and other MS Office Applications
- Expertise leveraging MS Office Suite, including advanced Excel and PowerPoint capabilities
- Collaborate cross functionally with leaders and colleagues' enterprise wide to solution, implement, and drive results.
- Travel requirements - up to 10% travel expected, based on needs of the business
- Ability to make decisions / recommendations under pressure and consistently deliver results on tight timelines
- Ability to develop content and present to senior leadership and cross-functional partners with a high degree of autonomy
- Experience building and presenting business cases to address complex business problems, requiring multi-phased strategies to accomplish goals
- Demonstrated growth mindset and willingness to learn and accept feedback
- Proven track record of high performance
- Plan and execute short- and long-term goals.
- Regular and reliable attendance during normal working hours, as established by the leader
- Self-directed individual requiring little direction
- Strong interpersonal skills as demonstrated by successful collaboration to achieve shared goals
- Strong communication skills in both formal and informal writing and speech • Demonstrating strong attention to detail and follow through with commitments.
- 3+ years of experience working with NCPDP standards and product implementation • 3+ years engaging and inspiring teams to achieve both short-term, and long-term goals.
- High level of attention to detail and ability to manage multiple assignments
- Experience in documenting IT requirements and summarization
- Experience with administrative claims data such as pharmacy or medical claims
- Experience in Retail Pharmacy
- Experience in Excel, PowerPoint, and other MS Office Applications
- Bachelor's degree, or equivalent experience
40Time Type
Full timePay Range
The typical pay range for this role is:$46,988.00 - $122,400.00This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.