Job Location: Arizona
- UAT Testing, including working with IT database admins to resolve issues.
- Maintains ongoing Service Category project, keeps track of requests and audits, organizes additional coverage as needed, updates documentation.
- Provides support for provider data transactions associated with projects, expansions, and new contract implementations. Resolves high volume/high impact systemic problems through proactive and reactive mechanisms (e.g., automation, route audit programs, data reporting, root cause analysis).
- Identifies, researches, and conducts root cause analyses (e.g., problem providers identified by PST, rework, and audit trends) and recommends process improvements. Establishes, maintains, and aligns complex contracted provider demographic data and negotiated reimbursement arrangements across provider systems. Creates and manages action plans for assigned projects relative to data quality and/or workflow improvements. Ensures that all impacted constituents are considered and appropriately addresses in action plans. Provides technical and/or functional leadership within unit. Performs validation of system enhancements. Extract information from provider systems to meet business reporting needs.
- SOX/SOC1 Audits, including meeting with external auditors to explain PSA processes
- Maintains ongoing Rate Calc project, identifying, troubleshooting, and updating Rate Calcs as needed to avoid claims issues. Must have extensive knowledge of how PCM works behind the scenes.
- Meets with various departments, Sr Leadership, and others to ensure system accuracy and provide feedback
Pay Range
The typical pay range for this role is:
Minimum: 43,700
Maximum: 97,400
Please 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
- Knowledge of PSA systems and processes (MCPS, PCM, CPD, SCM, CTS, PRMS, etc)
- Knowledge of Microsoft Word, Excel, and Teams
Preferred Qualifications
- Knowledge of Powerpoint, graphs, charts, and data analytics
- Ability to attend and lead meetings, providing information about PSA as needed
Education
Bachelor’s degree or equivalent experience
Business Overview
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. 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. 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.
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