Senior Manager, Provider Claims Diagnostics

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

**This position can be work at home or hybrid, dependent on where the candidate lives.**

The Provider Experience, Interoperability, Digital Solutions & Provider Operations organization provides foundational operational / enabling support for provider partners and the Network teams that directly interact with these providers. The Strategic Planning and Support team plays a key role in tracking and monitoring the health of critical business functions, supporting strategic initiatives, and partnering to elevate insights that can positively impact provider experience. The Senior Manager, accounts receivable Diagnostics, will leverage existing & new methodologies to help review, understand, and identify process improvements across key provider journeys including self-service / digital transactions, claims management, dispute resolution, and more. They will directly support certain strategic Provider Experience initiatives that enable our providers to deliver high quality, accessible, and affordable care for our members, work with the local market leadership team to share insights and learnings and stay connected to and translate key risks and wins to other parts of the organization.

This position will directly support several distinct activities, including:

• Invest in targeted reviews of specific datasets / trends to bring visibility to process improvement opportunities, both internal and external

• Serve as an internal subject matter expert to provide broader training & awareness regarding emerging learnings to help scale identified improvements

• Develop presentations, case studies, timelines, and related material to successfully implement strategy or change initiatives, including executive level presentations

• Partner with other teams within the organization to rationalize findings & lessons learned related to provider abrasion and facility/physician claim issues

• Help bring ‘voice of the provider’ into key workflow reviews, workshops, and related planning & prioritization exercises 

• Partner with local market teams to understand and account for trends impacted by contractual or other market-specific dynamics

• Monitor existing internal dashboards such as the Provider Experience and Analytics Tool to assess trends, surface outlier performance, and elevate progress

• Leverage strong project management skills to monitor implementation and achieve successful outcomes across multiple projects

• Establish contacts in diverse business areas to keep informed of new learnings and impact to Provider Experience

Required Qualifications

• A minimum of 7 years’ experience in one or more of the following areas: provider revenue cycle operations / optimization, payer relations, healthcare analytics.

• Ability to work collaboratively in a cross-functional team environment to solve challenging issues and identify opportunities for improvement.

• Ability to effectively interact with all levels of management.

• Demonstrates flexibility to support rapid adjustments to strategy and priorities to meet changing business requirements

• Demonstrate a proactive collaborative approach to service delivery and have a strong customer focus

• Conveys strong sense of urgency to drive issues to closure

• Demonstrated ability to analyze & synthesize quantitative and qualitative data to derive actionable solutions

• Experienced presenter with ability to provide different views for different levels (e.g., executive vs. end user)

• Strong project management experience

• Excellent verbal and written communication skills

• Strong organizational skills

Preferred Qualifications

• Prior experience across common claims management tools / resources including Availity provider portal, clearinghouse vendor partners, Electronic Data Interchange (EDI), practice management software, etc.

• Prior experience with Provider Network functions / processes and market dynamics.

• Working knowledge of QNXT, HRP, and ACAS.

Education