Medical Operations Analyst

CVS Health Cumberland, RI
Job Description

The primary responsibility of the Medical Operations Analyst is to support the Third Party Medical Claim Solutions team in order to increase collection, reduce bad debt, eliminate legal risk, and help ensure compliance to all federal/state requirements and CVS Health obligations.

The Analyst will focus on analyzing bad debt, determining root cause and then making recommendations for process improvements with payers, CVS entities, and/or CVS Health systems and processes.

The Analyst will also perform analysis and root cause diagnosis on denials/unpaid claims/ open cash and will suggest edits, process improvements, etc in order to reduce incoming exceptions in order to improve cash flow. This function supports the goals of recognizing and controlling bad debt through process enhancements and focused efforts in the timely resolution of denials.

The Analyst is also responsible for performing trend analysis, reviewing reports and current procedures, identifying issues, recommending/implementing process improvements, and ensuring compliance, as well as training of new hires on best procedures. In addition to supporting the Claim Solutions team, this associate will coordinate files for write offs and provide reporting to the claim reprocessing associate.

Required Qualifications

* 1+ years MS Office experience either academically or professionally.

Preferred Qualifications

* Third Party Receivable Experience

* 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.

* 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.

* Demonstrated ability to prioritize and organize work to accurately complete projects or assignments on schedule.

* Ability to complete routinely assigned work based on productivity standards (SLA) with minimal supervision.

* Ability to make intelligent decisions independently and collaboratively, contributing recommendations for resolution of issues.


Verifiable High School Diploma or GED

Business Overview

CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation's largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website:

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