Manager, Business Consultant

Job not on LinkedIn

🔥 0 minutes ago

🦀 Maryland, Massachusetts, +3 more states – Remote

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

💵 $60.3k - $132.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

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.

📋 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.

🎯 Requirements

• 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.

🏖️ Benefits

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