Senior Analyst, Business Analytics - Audit

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

• At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas members. We value diversity and are dedicated to helping you achieve your career goals .This is not an IT role.
• As a key member of the Network team, applies in-depth knowledge of health care provider contracts and provider data, network operations, and data audits to support the maintenance and growth of a regional health care provider network that meets or exceeds accessibility, compliance, quality, and financial goals.
• Engages in cross-functional collaboration to support operational aspects of negotiations for new and renewing provider agreements, acts as a subject matter expert on standard contract templates and required documentation, contract management tools, conducts audits as part of network expansion efforts and maintenance on provider contracts and data, and initiates and supports remediation efforts as needed.
• Assist with establishing and implementing results-based programs and innovative initiatives for the network operations area, under general supervision.
• Collaborate internally and cross-functionally to support initial negotiations and re-negotiations of complex health care provider contracts.
• Utilize recruitment databases and contract management tools to design, build, load, audit, and edit complex contracts, agreements, amendments and fee schedules for physician/medical groups, IPAs, hospitals, and ancillary providers to support provider network maintenance and growth.
• Conduct research, analysis, and audits to proactively identify or promptly respond to contract-related complications and propose solutions to protect data, maintain contract integrity, enhance contract performance, and resolve provider concerns. Provide team with technical and other expertise for questions related to contract management system and the information contained therein.
• Coordinate and support contracting-related activities including pre- and post-signature contract reviews, accurate financial analysis, contract approvals, contract processing, and post-execution contract management.
• Apply knowledge of network operations to offer constructive feedback or suggest innovative operational approaches that enhance organizational performance, efficiency and growth.

Required Qualifications

• 3-5 years of experience working in managed healthcare contracting, network management, or supporting roles.

Preferred Qualifications

• Bachelor’s Degree
• 3-5 years of experience with collaboration and cross-functional teamwork
• 3-5 years of experience with multi-tasking and prioritizing duties
• 3-5 years of experience with problem-solving and decision-making skills
• 1-2 years of experience maximizing data accuracy
• Compatible with a dynamic work environment
• Working knowledge of medical claims and coding.

Education

• High School Diploma or GED Required

Pay Range

The typical pay range for this role is:

$43,700.00 - $107,200.00

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 addit