Job Description As a Healthcare Encounter Analyst - Senior for claim reconciliation in the State Medicaid Encounters department, you will work exclusively with Pharmacy generated Medicaid encounters. You will be responsible for researching, analyzing and correcting previously submitted, rejected, Medicaid encounters. A self starter with a natural curiosity and a high attention to detail would be well suited for this role, as many potential issues and creative solutions, to those issues, have not been identified yet. This research includes, but is not limited to, examining setups/configurations as well as comparing text files and their contents to identify trends or issues with the integrity of the data within those files. Many innovative solutions are driven from this research and curiosity. You will also be responsible for serving a select group of clients. You will be responsible for maintaining, and in some cases developing, a relationship with key parties on the client side. Part of developing/maintaining a great working relationship with each client will include providing recurring metric reports to keep the client up to date. For the most part, these metrics are produced from SAS and a proprietary version of AS400. Experience with either of these systems or prior exposure to the PBM or Medicaid industry would be advantageous. The ability to think critically and multitask is very valuable in this role. Additionally, you will be an integral part of recurring client meetings. You must be comfortable and adept with clearly communicating technical information (verbal and written) to non technical people and leading conference calls, when needed.
As part of our CVS Health team, you will be empowered to make decisions and think outside of the box, as we truly value innovation. Our team has expanded rapidly and will provide room for growth in the future. This is an excellent opportunity to be part of a multi-functional team which treats each other like family.
Required Qualifications - 1+ years of professional work experience, preferably in a related field such as data analysis.
- 2+ years of experience using Excel in a professional or academic setting.
Preferred Qualifications - 3+ years of professional work experience, preferably in a related field such as data analysis.
- 3+ years experience with Excel and Access (and have previously built queries)
- Must have strong problem solving skills with the ability to work independently
- Great communication skills, as the position will involve communicating with clients
Education High school diploma/GED required. Bachelor's degree preferred.
Business Overview It's a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. As a CVS Health colleague, you'll be at the center of it all.
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.
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