Medical Operations Analyst

CVS Health Retail Cumberland, RI
Position Summary

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.

Position Summary

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.

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.

Required Qualifications

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