Mgr, Project Management (IC)

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.

Position Summary
This position is a Product Owner of the provider digital experience focusing on the Encounter transaction and involves ownership of the encounter submission and end to end processing to ensure the enterprise receives the information needed for risk revenue and information on services rendered to our members. Collaborates with the claim Clearinghouses, and other internal business areas like Network Management and system Product Owners to troubleshoot issues and ensure end to end smooth processing across Commercial and Medicare Lines of business. The role monitors the health of the encounter experience for our providers using data analytics;  researches and manages issue; participates in strategy development and plays a critical role in ensuring encounter completeness, data quality, and vendor accountability.

Fundamental Components

• Supports business policy and regulatory compliance.
• Supports ongoing strategy and business development.
• Collaborates with business and IT constituents across key functional areas/lines of business to understand potential project impact on the transaction, organization, align project work, and execute activities accordingly.
• Monitors and uses metrics to make appropriate business decisions.
• Presents to internal/external customers, constituents and business partners, strong business as well as systems knowledge and can perform reasonability checks.
• Performs issue analysis by utilizing system information, business knowledge and industry transactional guidelines.
• Influences change or enhancements to business processes, policies and system infrastructure to improve information quality, availability and access.
• Develops and participates in presentation and consultation to existing and prospective customers, business partners and internal business areas on information services, capabilities and performance results.
• Proactively evaluates project activities, builds contingency plans, executes corrective action, and monitors issue resolution to mitigate risks such as scope and/or budget.
• Collaborates with Provider eSolutions and across business areas (e.g., Provider Data Maintenance, Network Management) to diagnose issues, deploy solutions, and maintain efficient business processes.
• Supports end-to-end implementation of encounter transactions and provides necessary training for providers and transaction vendors.
• Supports onboarding of new entities to ensure successful encounter data submission.
• Maintains collaborative working relationships with external vendors and capitated physician groups, IPAs, PHOs and hospital systems.
• Partners with contracted vendors and capitated physician groups, IPAs, PHOs and hospital systems to measure encounter performance and improve encounter data quality.
• Ensures all appropriate vendor linkages are established and maintained to facilitate provider utilization of system applications.
• Engages in cross-functional projects and process improvement efforts to strengthen encounter operations and support business objectives.

Required Qualifications

• 3-5 years’ experience directly related to the duties and responsibilities specified, or an equivalent combination of education and work experience.
• Advanced knowledge of provider electronic transactions.
• Strong organizational skills and ability to drive resolution across internal and external stakeholders.
• Comfortable navigating ambiguity and evolving processes.
• Very strong interpersonal, relationship management, writing and presentation skills.
• Proven project leadership experience.
• Ability to use Excel and comfort with MS Office applications.
• Intermediate to advanced proficiency in Excel.
• Familiarity with Provider electronic transactions.

Preferred Qualifications

• Experience with 837 formatting or provider electronic transactions.
• Network Management experience a plus.
• Capitation and Delegation knowledge, including impact on provider contracts and encounter submissions, preferred.
• Strong working knowledge of at least one of the following systems: EPDB, ACAS, EWM, HRP.
• Familiarity with EDI.
• Familiarity with APLC – Agile an