Medical Operations Analyst

CVS Health - Cumberland, RI (30+ days ago)3.5

The primary responsibility of the Medical Operations Analyst is to support the Third Party Small Payer team in order to increase collection, reduce unbilled claims and bad debt, eliminate legal risk, and help ensure compliance to all federal/state requirements and CVS Health obligations.

The Analyst will focus on analyzing bad debt, determining root cause and then making recommendations for process improvements with payers, CVS entities, and/or CVS Health systems and processes.

The Analyst will also perform analysis and root cause diagnosis on unbilled/denied/unpaid claims/open cash and will provide recommendations for edits, process improvements, etc. in order to reduce incoming exceptions in order to improve cash flow. This function supports the goals of recognizing and controlling bad debt through process enhancements and focused efforts in the timely resolution of claim exceptions

The Analyst is also responsible for performing trend analysis, reviewing reports and current procedures, identifying issues, recommending/implementing process improvements, and ensuring compliance, as well as training of new hires on best procedures.

Required Qualifications
  • 1+ years MS Office experience either academically or professionally.
Preferred Qualifications
  • Third Party Receivable Experience
  • Medical Billing Experience
  • Excellent analytical and root cause diagnosis skills along with the ability to influence decisions by creating a strong case for action by leveraging analytical tools.
  • Strong problem resolution skills. Ability to work individually or with a team to systematically identify and define problems, evaluate alternatives and implement practical, cost-effective solutions.
  • Ability to frame recommendations and formally present them to management.
  • Demonstrated ability to prioritize and organize work to accurately complete projects or assignments on schedule.
  • Ability to complete routinely assigned work based on productivity standards (SLA) with minimal supervision.
  • Ability to make intelligent decisions independently and collaboratively, contributing recommendations for resolution of issues.
Verifiable High School Diploma or GED

Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.