Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. Position Summary
- Provide evaluation of vendor outcomes used for At-Time-of-Care Risk Adjustment solutions
- Provide data analytic and evaluation support as assigned
- Conduct data deep dives to identify unique and innovative opportunities for RAF improvement
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The Sr Analyst will play a key collaborative role in supporting the organization's risk adjustment strategies and operations through advanced data analysis. This position involves analyzing all risk adjustment-related data to identify trends, gaps, and opportunities for improving risk adjustment factor (RAF) scores. The Sr Analyst will, at the direction of leadership, provide actionable insights that enhance coding accuracy, optimize revenue, and ensure compliance with CMS and HHS regulations. The ideal candidate has a strong analytical mindset, experience with healthcare data, and proficiency in data analysis and data visualization tools.Required Qualifications
Minimum Qualifications
- 3+ years of risk adjustment working knowledge and understanding within the Medicare, Commercial ACA, and/or Medicaid line of business.
- Management consulting, business process consulting and/or strategic business planning
- Enterprise-wide and/or cross-functional large-scale initiatives with high degree of complexity
- Demonstrated experience successfully implementing change in regulated and highly complex organizations
- Technical Expertise: Proficiency in SQL, Python, R, or SAS for data analysis and statistical modeling
- Data Visualization: Experience with BI tools like Tableau, Power BI, or Quick Sight to create dynamic, user-friendly reports and dashboards
- Healthcare Experience: Knowledge of healthcare risk adjustment methodologies, including HCC coding, RAF score calculation, and CMS risk adjustment guidelines
- Analytical Skills: Strong analytical mindset with experience in statistical analysis, trend identification, and performance monitoring
- Attention to Detail: High level of accuracy in reviewing data, identifying errors, and ensuring compliance with regulations
- Project Management: Ability to manage multiple projects, prioritize tasks, and deliver insights within deadlines
- Excellent knowledge of Microsoft Office products including Excel, PowerPoint, Forms, Visio, etc
- Excellent computer, proof reading, and written and verbal communication skills. Excellent interpersonal skills including the ability to communicate effectively with internal and external customer base
- Ability to lead, work independently, proactively with limited supervision, and in a collaborative manner
- Ability to work under pressure. Ability to maintain the security of confidential information
- Relevant certifications (i.e. Certified Healthcare Data Analyst CHDA)
- Bachelor's degree in Business Administration/Management, Finance, Economics, Statistics, Mathematics, Data Science, HIM, Information Systems, Computer Science, or other relevant degree or 3 years of equivalent work experience in lieu of degree
40Time Type
Full timePay Range
The typical pay range for this role is:$46,988.00 - $102,000.00This 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.
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 HealthWe anticipate the application window for this opening will close on: 03/01/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.