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Position Summary

Medicaid EDI and Intake Business Operations team is looking for a dynamic and initiative-taking analyst with a strong background in EDI claim transactions and claims operations. This team is responsible for the quality and integrity of our EDI and Intake processes for all of Medicaid incoming transactions. In this role you will liaise with all potential sources of provider inquires around EDI and Claims Intake rejections and serve as the EDI Technical SME to gatekeep all the intake rules and matching logic. You will collaborate with the IT teams for system enhancements and fixes. You will provide second-level expert support for EDI and Intake rejections, function as the SME on EDI transactions and possess technical skillsets to query and analyze large amounts of data for research and troubleshooting issues.

Primary duties and responsibilities

• Support Product Owners, Business Owners and Leads, using technical and analytical expertise along with EDI and Claims processing knowledge to support the service operations teams.

• Interface and communicate at varying levels of the organization, including direct communication with cross-functional areas across the company; coordination with Operations, SMEs and IT teams will be key to success.

• Drive requirements for claim intake rules, provider and member selection logic and liaise with Agile team(s).

• Create, update, and maintain all documentation surrounding EDI and Intake rules such as requirements, process diagrams, solution diagrams, etc.

• Perform analysis of EDI and Claims intake rejections stemming from internal as well as stakeholder inquiries including provider calls while also tracking and executing solutions.

• Subject Matter Expertise on EDI transactions (837s, 277, 835, 275, etc.) along with technical skillset to build ad hoc queries, data transformations, and data analysis for research and troubleshooting.

• User Acceptance Test logic changes and enhancements.

Required Qualifications

• 2+ years working on EDI transactions including but not limited to 837s, 277s, 999s, 275s, 835s, etc.

• 2+ years of project management experience, preferably in EDI and Claims operations.

• 5+ years of data interpretation and analysis experience

• 5+ years of demonstrated leadership.

• 5+ years querying large datasets using SQL, SAS, or other data tools.

• Proficient in Word, PowerPoint, Excel

• Initiative-taker with the ability to work independently and effectively prioritize multiple deliverables.

• Demonstrated ability to manage conflicting priorities and multiple projects concurrently.

• Excellent verbal and written communication skills with ability to communicate technical ideas and results to non-technical clients in written and verbal form.

• Strong problem-solving, analytical, and critical thinking skills

Preferred Qualifications

• Demonstrated ability with Excel (pivots, formulas, and V-look up),

• Flexibility and the willingness to adapt to meet the needs of the team

• Someone who is initiative-taker and comfortable in a fast-paced and ever-evolving environment.

• A life learner who is constantly working to improve their professional knowledge.

• A process improvement mindset, always looking to improve processes.

Education

Bachelor’s degree or equivalent in Information Systems, Computer Science, or Delivery Management or equivalent combination of education and experience.

Pay Range

The typical pay range for this role is:

$60,300.00 - $145,860.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 11/22/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.