Decision Analyst – SME, Medical Coding, FWA Ideation

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.

Position Summary
Position dedicated to supporting the Fraud, Waste & Abuse program within Analytics & Behavior Change. This resource will be asked to drive workflow/inventory for the program.  Conduct project management actions within this program, including daily oversight and management of medical records inventory, ongoing monitoring, responding to program inquiries, trend research outcomes, and updating project documentation as needed. Identifies and researches program-specific issues, identifies solutions and works with leadership to find resolution of issues while working with internal business partners, external vendors, and providers. Please replace this section with the Job Summary

Required Qualifications

• Minimum of three to five years industry experience with health care claims, claim processing, and claim platforms
• Proficient in QuickBase
• Ability to work independently
• Strong analytical and research skills
• Proficient in researching information and identifying information resources related to fraud, waste and abuse
• Detail-oriented
• Strong verbal and written communication skills
• Ability to interact with different groups of people at different levels
• Ability to utilize company systems to obtain relevant electronic documentation
• Knowledge of Aetna’s policies and procedures
• Coding Certificate (if applicable)

Preferred Qualifications

• Preferred Bachelor’s degree or three years of equivalent experience in the industry
• 3+ years in claims processing knowledge and experience within ACAS, QNXT or HRP (HRP strongly preferred).
• Demonstrated written and verbal communication skills with the ability to present information to various audiences.
• Proficiency in Word, Excel, Database search tools, and the use of the Intranet/Internet to research information.

Education

• Preferred Bachelor’s degree or three years of equivalent experience in the industry
• 3+ years in claims processing knowledge and experience within ACAS, QNXT or HRP (HRP strongly preferred).

Pay Range

The typical pay range for this role is:

$64,890.00 – $129,800.00

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 jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 04/24/2024