Manager, Business Consultant

Emploi pas sur LinkedIn

🕒 il y a 1 mois

🦀 Maryland, Massachusetts, +3 états de plus – Distant

🦀 Maryland – Remote 🍂 Massachusetts – Remote 🔔 Pennsylvania – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote

💵 $60 300 - $132 600 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

💼 Consultant

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CVS Health

Site WebLinkedInTous les Emplois

10 000+ employés

Fondée en 1963

🏥 Santé

⚕️ Assurance santé

🛒 Commerce de détail

Healthcare • Healthcare Insurance • Retail

CVS Health est une entreprise américaine de premier plan dans le domaine de la santé, dédiée à l'amélioration de l'accès et de l'accessibilité financière des soins de santé. L'entreprise s'appuie sur une approche globale qui comprend les services de santé, l'assurance santé et la gestion des prestations pharmaceutiques. À travers ses filiales, telles qu'Aetna et CVS Caremark, CVS Health propose une gamme de services qui favorisent le bien-être, la gestion des maladies chroniques et une couverture abordable des médicaments prescrits. CVS Health exploite des pharmacies de proximité, fournit des services de pharmacie par correspondance et gère des programmes de médicaments spécialisés, visant à rendre les soins de santé pratiques et accessibles à tous. Animée par une mission de connecter les individus aux services de soins essentiels, CVS Health s'engage à favoriser des communautés en meilleure santé et à soutenir le bien-être de toutes les personnes.

Description

• Serve as the subject matter expert for state-specific encounter data submission requirements and maintain comprehensive documentation of all applicable regulations and processes. • Lead the end-to-end management of encounter submissions, ensuring compliance with state and regulatory requirements. • Partner with technical teams and vendors to implement, monitor, and maintain processes that support accurate encounter data reporting and submissions. • Oversee 837 file transmission processes, ensuring files are submitted accurately, timely, and in accordance with state specifications. • Manage state response files, reconciliation activities, and error reporting to ensure all submitted transactions are accounted for and resolved. • Establish and maintain reporting, monitoring, and tracking processes for encounter submission performance, acceptance rates, and error trends. • Drive root cause analysis and coordinate corrective actions to resolve encounter submission errors and improve data quality. • Develop, document, and enhance operational processes related to encounter data management and state reporting. • Collaborate with cross-functional teams including Claims, IT, Compliance, Operations, Risk Adjustment, and vendor partners to ensure alignment and successful execution of encounter submission objectives. • Support audits, regulatory reviews, and internal compliance initiatives related to encounter data submissions. • Monitor changes in state and federal requirements and lead implementation efforts to maintain ongoing compliance.

🎯 Exigences

• Minimum of 5 years of experience in healthcare claims operations • At least 2 years of experience overseeing secure data transmission processes utilizing SFTP and other file transfer technologies • 3+ years of experience in data management, including data validation, reconciliation, reporting, and issue resolution. • 3+ years of leadership experience with demonstrated success managing workflows and leading, developing, and supporting teams within a healthcare operations environment. • Bachelor's degree preferred or a combination of professional work experience and education.

🏖️ Avantages

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