CVS Health - Austin, TX
posted 3 months ago
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. As a Senior Informatics Developer within the Revenue Integrity organization, you will be leading Risk Adjustment technical activities, not limited to electronic medical record data extraction, reconciliation and aggregation, and financial and operational reporting. You will provide guidance and direction to external vendors, external consultants, team members and/or matrixed staff as required to support ACA IFP Risk Adjustment Revenue Integrity initiatives. You will be responsible for leading the reconciliation of data (coding review results and medical record images) from different sources, identifying gaps within the process, and leading to develop more efficiency within the process. Acting as the business lead for system design and testing new functions, you will also support auditing activities related to vendor reconciliation of coding results and medical record images as well as other technical projects. Your role will drive change related to enhancements and system fixes, understanding interdependencies in both process and timing to further business objectives. To be successful, you will use your knowledge and experience to create meaning from the data. This position also supports coordination across all shared services and vendors to assure data integrity and data validation processes are in place. You will be responsible for auditing tasks including documenting and evaluating critical controls, understanding procedures, results, and business impacts; and documenting and expressing such understanding in both written and verbal form. You will conduct periodic updates of analytical routines and department production systems, investigating and evaluating alternative solutions to meet business needs. Supporting 1 million IFP members, you will tightly manage vendor data quality and timeliness, ensuring data is ingested into CREW to drive submissions, and working timely to resolve any CREW validation errors to ensure submission completeness. You will analyze and understand digital retrieval to maximize results and customize ACA reporting views and outreach manager data needed for day-to-day operations work.