CVS Health has an exciting opportunity for an Informatics Manager to join our dynamic Risk Adjustment Analytics team! In this role you will provide complex analytics and reporting to support Medicaid Risk Adjustment to address business questions regarding population health management, health and economic outcomes, and other business needs.

Perform data and analytical services in support of optimizing risk adjusted revenue, maintaining compliance with CMS standards, and modeling financial impacts of changes in risk adjustment data and methodologies.

Collaborate regularly with internal departments, including but not limited to: Finance, Medicare Operations, Network Management, Provider Contracting, and Health Economics, and external vendors on risk adjustment projects.

Organize, prioritize, and manage various simultaneous tasks/projects to meet deadlines. Understand various areas of the business and operational processes relevant to the project's goals.

Assist in performing analyses used in the development of financial plans, re-forecasts, and other financial projections.

Work on identifying gaps in the claims, encounter reconciliation process, and provide insights to educate providers.

Build reports and dashboards to track risk adjustment related projects and evaluate the effectiveness of those initiatives.

Responsibilities

• Produce trends month by month, year over year and other complex reports & analyses
• Interact with business partners to gather requirements and translate technical language
• Lead meetings with internal technical teams on in office program solutions
• Provide analysis and recommendations for process improvements
• Ensure accuracy of all monthly & supplemental data feed extracts
• Deliver projects, reports, updates, etc. on timely basis
• Produce ad hoc reports as requested

Join this exciting opportunity to collaborate directly with different teams across the organization and have a meaningful impact on our business!

Successful candidates will possess the following abilities:

• Expertise working with large complex data sets, and performing root cause analyses
• Willing to probe into technical details, and problem solve
• Ability to use data to drive business outcomes and decisions
• Be organized and exhibit attention to detail
• Ability to effectively calculate and communicate forecasts/projections
• Juggle multiple priorities

Required Qualifications

• 5 or more years of data analytics experience
• 3 or more years of experience in technical programming fundamentals in SQL, SAS, or other data management software
• 3 or more years of experience in creating reports and pivot tables in Excel

Preferred Qualifications

• Knowledge of government-regulated healthcare programs such as Medicaid or Medicare
• Healthcare experience or knowledge of health insurance concepts
• Working knowledge of CPT, ICD, and NDC codes
• Risk Adjustment experience/knowledge
• Attention to detail and working independently

Education

Bachelor's Degree or equivalent work experience required

Pay Range

The typical pay range for this role is:

$60,300.00 - $145,860.00

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 Benefits | CVS Health

We anticipate the application window for this opening will close on: 02/24/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.