CVS Health - Providence, RI
posted 3 months ago
At CVS Health, we are committed to enhancing human-centric health care, and as a Senior Informatics Developer within the Revenue Integrity organization, you will play a pivotal role in this mission. This position is designed for a professional who is ready to lead technical activities related to Risk Adjustment, which includes electronic medical record data extraction, reconciliation, aggregation, and financial and operational reporting. You will be responsible for guiding and directing external vendors and consultants, as well as team members, to support the ACA IFP Risk Adjustment Revenue Integrity initiatives. Your expertise will be crucial in leading the reconciliation of data from various sources, identifying gaps in processes, and developing strategies to enhance efficiency. In this role, you will act as the business lead for system design and testing of new functions, while also supporting auditing activities related to vendor reconciliation of coding results and medical record images. You will drive change by understanding interdependencies in processes and timing to align with business objectives. Your ability to create meaning from data will be essential for success. Additionally, you will coordinate across shared services and vendors to ensure data integrity and validation processes are in place. This includes auditing tasks, documenting critical controls, and expressing your understanding of procedures and business impacts in both written and verbal forms. You will also conduct periodic updates of analytical routines and department production systems, investigate alternative solutions to meet business needs, and support 1 million IFP members by managing vendor data quality and timeliness. Your role will involve ensuring data is ingested into CREW for submissions, addressing CREW validation errors promptly, analyzing digital retrieval processes, and customizing ACA reporting views to support day-to-day operations.