Senior Manager, MPPS Policy Business Analytics

Job not on LinkedIn

🔥 17 hours ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $67.9k - $182.5k / year

⏰ Full Time

🟠 Senior

📉 Data Analyst

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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.

📋 Description

• The Sr. Mgr. Business Analytics is responsible for developing, maintaining, and automating reports and dashboards that track the performance of medical and payment policies. • By delivering data-driven insights to leadership and other stakeholders, this role helps optimize business processes, ensure policy compliance, and identify opportunities for efficiency improvements and cost savings. • Extract, validate, and interpret large datasets from healthcare claims, authorizations, and payment systems. • Conduct exploratory data analysis to identify patterns, trends, and deviations in payment or utilization. • Evaluate medical and payment policy operations, identifying trends, patterns, and variances related to: Medical cost drivers and utilization patterns. • Analyze effectiveness of medical and pre-payment policies, and precertification for delivery of insights on performance to leadership. • Collaborate with stakeholders to gather business requirements for new systems and process improvements. • Automate recurring reporting processes and workflows to improve statistical efficiency and free up resources for more complex analysis.

🎯 Requirements

• 5-7+ years of experience in a data or business analyst role, preferably within the healthcare or health insurance industry with payment integrity, i.e. medical and payment policies, for executives and decision making • 2-3 years analyzing claim editing rules for payment accuracy and trends • Demonstrated proficiency in SQL for querying and manipulating large datasets. • Experience in developing reports and dashboards using data visualization tools like Microsoft Power BI, Tableau and QuickBase Tools. • Experience with claims data, eligibility data, and medical and payment policy analytics. • Knowledge of healthcare industry coding systems, including ICD-10 and CPT. • Familiarity with data governance concepts and data management best practices. • Preferred: Medical coding certification, ie, Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or other certifications preferred. • Bachelor's degree in a field such as Finance or Mathematics, or similar field

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs