About the role
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
This role will be responsible for developing provider data, credentialing and additional reporting for internal, external, and departmental customers as required by the business and manage relationships and the reporting process from initiation through submission. This position will monitor compliance with requirements as needed by the business; gathering data from multiple sources to create reporting, identify trends, and ensure accuracy and completeness to inform strategic decision making. Manage the direct execution and documentation of the internal provider sanction process, monitor the sanction dashboard, and communicate with stakeholders on sanctioned and terminated providers. Function as a key operational control role, supporting audit readiness, regulatory compliance, and beneficiary protection. Manage projects to ensure on-time completion according to requirements and within expected timeframe of completion and additional assignments as needed by the business.
What you will do
- Collect, analyze, and present data related to the provider data and credentialing processes.
- Interpret data, identify trends, and draw meaningful conclusions.
- Execute timely and accurately on the flagging of sanctioned providers to ensure they are removed from directories and claims payments are stopped and/or recovered.
- Maintain complete audit trails to support the work completed.
- Support updates to SOPs, job aids, and training materials.
- Manage multiple reporting projects with varying due dates and levels of priority.
- Identify recurring data issues or control gaps and recommend & execute on process improvements.
- Assess the impact of adopting new business analysis advances and make recommendations for their implementation.
- Assist with evaluating new technology, tools, and systems that can enhance business processes and operations.
- Collaborate with cross-functional teams, under minimal supervision, to gather and document business requirements, translate them into technical specifications, and provide recommendations for technology solutions.
- Develop skills outside of an existing comfort zone and encourage others to do the same.
- Effectively mentor others.
- Address conflicts or issues, engaging in difficult conversations with clients, team members and other stakeholders, escalating where appropriate.
Requirement Qualifications
- 5+ years of data analysis and reporting experience
- Adept at problem solving and decision making
- Strong attention to detail and documentation accuracy
- Demonstrates experience handling sanctions/exclusions, regulatory or internal audits, and/or similar work with high compliance risk
- Experience in collaboration and cross functional teamwork
- Demonstrates strong verbal and written communication skills, with the ability to clearly articulate complex information to diverse audiences, including leadership and external stakeholders
- Track record of execution and delivery (planning, delivering, and supporting) skills
- Experience in provider data and provider credentialing
- Experience in data warehousing , SQL Queries and PowerBI
Preferred Qualifications
- Certified Analytics Professional (CAP)
- QNXT, EPDB and/or PRMS system experience
Education
- Bachelor's degree preferred/specialized training/relevant professional qualification.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$66,330.00 - $145,860.00This 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Aplyr's read
CVS Health is a healthcare giant blending retail pharmacy with insurance services, ideal for those interested in diverse healthcare roles and innovation.
What's promising
- •CVS Health's integration of pharmacy and insurance offers diverse career paths.
- •Strong focus on healthcare innovation with initiatives like HealthHUB locations.
- •Extensive national presence provides job stability and opportunities for relocation.
What to watch
- •Recent layoffs in certain divisions raise concerns about job security.
- •High-pressure retail environment may lead to employee burnout.
- •Complex organizational structure can slow decision-making processes.
Why CVS Health
- •CVS Health's acquisition of Aetna uniquely positions it in both retail and insurance sectors.
- •HealthHUB stores offer a distinctive model combining retail and healthcare services.
- •CVS Caremark provides a robust platform for pharmacy benefits management.
Aplyr’s read is generated by AI from public sources. Was it useful?
About CVS Health
CVS Health is a healthcare company that provides a range of services including pharmacy benefits management, retail pharmacy, and health insurance services.