Business Consultant Manager

1 week ago

New York, New York, United States CVS Health Full time
Job Summary

We are seeking a highly skilled Business Consultant Manager to join our Revenue Integrity team at CVS Health. As a key member of our organization, you will be responsible for leading Risk Adjustment technical activities, including electronic medical record data extraction, reconciliation, and aggregation, as well as financial and operational reporting.

Key Responsibilities
  • Provide guidance and direction to external vendors, external consultants, team members, and/or matrixed staff to support ACA IFP Risk Adjustment Revenue Integrity initiatives.
  • Lead the reconciliation of data from different sources, identifying gaps within the process, and develop more efficiency within the process.
  • Act as business lead for system design and testing new functions, as well as, the support of auditing activities related to vendor reconciliation of coding results and medical record images.
  • Drive change related to enhancements and system fixes, understanding interdependencies both process-wise and timing-wise to further business objectives.
  • Support 1m IFP members through tightly managing vendor data quality and timeliness, ensuring data is ingested into CREW to drive submissions, and analyzing and understanding digital retrieval to maximize results.
Requirements
  • Experience with IT application development lifecycles, methodologies.
  • Experience with SAS/SAS EG/Python/SQL server in data analytics and manipulation.
  • Experience with BI tools, including Tableau, Quicksight, PowerBI.
  • Vendor management experience.
  • Experience with CMS Risk Adjustment programs.
  • 5+ years of healthcare, health insurance, or relevant combination of experience.
  • 5+ years of experience with several of the following methodologies: management consulting, project consulting, business process consulting, financial strategic analysis, strategic business planning, and/or risk management consulting.
Preferred Qualifications
  • Experience documenting business processes, as well as, recommending and implementing improvement strategies.
  • Participates in system design.
  • Strong problem-solving, analytical, critical thinking, and project management skills.
  • Experience influencing others by turning data into meaningful and actionable information.
  • Ability to perform testing functions.
  • Ability to audit the accuracy of reporting against source documents/reports/databases.
  • Ability to implement auditing procedures.
  • Attention to detail.
  • Strong negotiation skills.
Education

Bachelor's degree in Mathematics, Economics, Statistics, Computer Science, Actuarial Science, Social Science, Healthcare, or related discipline or equivalent professional work experience.

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