Manager – ACAS Contract Pricing Test SME

Job not on LinkedIn

November 21

🦌 Connecticut – Remote

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

💵 $66.3k - $145.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

Apply Now

Receive Emails with Similar Jobs

CVS Health

WebsiteLinkedInAll Job Openings

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

• Review test outputs and identify discrepancies in pricing between old and new contracts • Validate pricing logic and ensure accurate interpretation of contract terms • Apply deep knowledge of provider contracts to assess compliance and accuracy • Interpret complex contract language and translate it into testable requirements • Investigate root causes of pricing mismatches and recommend corrective actions • Collaborate with IT and business teams to resolve identified issues • Partner with BIR teams to ensure timely review and approval of pricing test results • Communicate findings and recommendations clearly to stakeholders • Maintain detailed documentation of test results, mismatches, and resolutions • Ensure adherence to governance standards and compliance requirements • Identify opportunities to enhance pricing validation processes and tools • Contribute to best practices for contract interpretation and pricing accuracy

🎯 Requirements

• 3 + years in provider contract testing, pricing validation, or related functions • 3 + years of strong understanding of claims adjudication systems and pricing methodologies • 3 + years of proficiency in Excel and data analysis tools • Experience with commercial and Medicare programs and provider network pricing • Familiarity with automation tools and test management systems • Knowledge of regulatory requirements impacting pricing and contracts • Advanced analytical and problem-solving skills • Ability to interpret complex contract terms and apply them to testing scenarios • Excellent communication and stakeholder management abilities • Bachelor’s degree required or equivalent work experience

🏖️ 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