Senior Analyst, Provider Compliance

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6 hours ago

🥔 Idaho – Remote

Although this job is listed in Idaho, this company may be open to hiring remote in other states.

🔔 Pennsylvania – Remote

Although this job is listed in Pennsylvania, this company may be open to hiring remote in other states.

+1 more states

🥔 Idaho – Remote 🔔 Pennsylvania – Remote 🍁 Vermont – Remote

💵 $47k - $122.4k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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CVS Health

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Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• Lead and ensure the delivery of high-quality internal and external Medicaid provider audit results, regulatory compliance activities, and proactive risk mitigation strategies • Apply deep expertise in compliance, business operations, analytics, and communication to develop and execute strategies that support regulatory and contractual obligations • Partner cross-functionally to support accurate, complete, and timely audit and regulatory deliverables, standardize processes, optimize workflows, and enable data integrity across the organization • Drive and support provider compliance initiatives that promote consistency, accuracy, compliance, and operational excellence

🎯 Requirements

• Minimum of 3 years of progressive experience in audit, compliance, or related healthcare operations • Proven ability to develop and execute detailed project plans with accountability and rigor to deliver complex initiatives successfully • Strong analytical skills with demonstrated ability to interpret data, identify trends, and recommend actionable solutions for compliance-related challenges • Experience with Microsoft Excel with advanced proficiency for data analysis and reporting to strengthen internal controls and mitigate risk • Exceptional ability to convey complex information clearly and concisely, build relationships across organizational levels, and influence decision-making • Ability to lead initiatives, mentor team members, and thrive in a fast-paced, evolving environment while maintaining compliance and quality standards • 5 years of progressive experience in audit, compliance, or related healthcare operations (preferred) • Ability to interpret and apply business knowledge to implement state and federal laws and regulations impacting healthcare operations (preferred) • Three or more years of demonstrated success leading audits, complex projects, ensuring timely delivery, and driving measurable outcomes (preferred) • Three or more years of experience managing provider data operations, including compliance (preferred) • Three or more years of experience in network management, contracting, or related healthcare network functions (preferred) • One or more years of hands-on experience with provider data management platforms (preferred)

🏖️ Benefits

• Affordable medical plan options • 401(k) plan (including matching company contributions) • 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