CVS Health - Trenton, NJ
posted 2 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 primary responsibilities will include leading the reconciliation of data from various sources, identifying gaps in processes, and developing strategies to enhance efficiency. 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. Your role will require you to drive change by understanding interdependencies in processes and timing to align with business objectives. You will utilize your knowledge and experience to derive meaningful insights from data, ensuring that data integrity and validation processes are maintained across all shared services and vendors. In addition to these responsibilities, you will 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. This includes ensuring data ingestion into CREW for submission completeness and analyzing digital retrieval processes to maximize results. You will also customize ACA reporting views and manage outreach data necessary for day-to-day operations.