Pharmacy Account Management Analyst, Revenue Cycle

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Position Summary
The primary responsibility of this Pharmacy Account Management Analyst role is to support the Third Party Account Management team by maximizing collections, reducing bad debt, creating process improvements and helping to ensure compliance to all federal/state requirements and CVS Health obligations.
This person will perform analysis and root cause diagnosis on various Third Party activities related to overpayments/liabilities, and remittance exceptions for our Commercial/Medicaid payers. This function supports the goals of recognizing and controlling bad debt through recommending and implementing process enhancements and ensuring that payments are posting to the appropriate claims in a timely fashion.
This role is also responsible for performing trend analysis on payer exceptions, reviewing reports and current procedures for Commercial/Medicaid payers, identifying issues, recommending/implementing process improvements, and ensuring that all overpayments and liabilities are researched and resolved in accordance with the OIG agreement.
In addition to supporting the Pharmacy Account Management team, this analyst will coordinate files for write offs and will work closely with our system partners by attending requirement meetings, identify and report defects as well as follow up on the resolution, and recommending and writing change requests in order to streamline current processes.
Required Qualifications
- 1+ years of analytics experience
- Solid working knowledge of all MS Operating Systems and MS Office applications (MS Word, Excel, Access, PowerPoint), and process mapping software such as Microsoft Project and Visio. Familiarity with MicroStrategy, SQL, and other data mining tools preferred.
Preferred Qualifications
- Demonstrated ability to prioritize and organize work to accurately complete projects or assignments on schedule.
- Strong problem resolution skills. Ability to work individually or with a team to systematically identify and define problems, evaluate alternatives and implement practical, cost-effective solutions.
- Ability to frame recommendations and formally present them to management
- Excellent analytical and root cause diagnosis skills along with the ability to influence decisions by creating a strong case for action by leveraging analytical tools.
- Ability to maintain composure and perform job duties/responsibilities when confronted with stressful situations
- Excellent verbal and written communication skills and the ability to interact professionally with a diverse group -directors, managers, colleagues, and external entities
- Ability to work in strict confidence, ensuring the confidentiality of the patient and medical and financial records at all times, in compliance with company and HIPAA Privacy guidelines
- Flexibility to adapt to a changing environment, quickly making sound decisions.
Education
Bachelors Degree or equivalent work experience
Pay Range
The typical pay range for this role is:
$40,600.00 - $87,500.00
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 jobs.CVSHealth.com/benefits
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.