CVS Health - Hartford, CT
posted 4 months ago
As a Senior Informatics Developer within the Revenue Integrity organization at CVS Health, you will play a pivotal role in leading technical activities related to Risk Adjustment. This includes the extraction, reconciliation, and aggregation of electronic medical record data, as well as financial and operational reporting. Your responsibilities will encompass providing guidance and direction to external vendors and consultants, as well as team members, to support the ACA IFP Risk Adjustment Revenue Integrity initiatives. You will be tasked with 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 expertise will be crucial in creating meaningful insights from data, ensuring data integrity, and validating processes across shared services and vendors. You will also be responsible for auditing tasks, documenting critical controls, and communicating findings effectively. Additionally, 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 to maximize results. You will customize ACA reporting views and manage data needed for daily operations, making your role essential in driving the success of the organization’s initiatives.