Healthcare Encounter Senior Analyst

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About the role

As a Healthcare Encounter Analyst - Senior for claim reconciliation in the State Medicaid Encounters department, you will work exclusively with Pharmacy-generated Medicaid encounters. You will research, analyze, and correct previously submitted, rejected Medicaid encounters. This role is ideal for a self-starter with natural curiosity and high attention to detail, as many potential issues and creative solutions have not yet been identified.

Your research will include examining setups/configurations and comparing text files to identify trends or data integrity issues. Many innovative solutions stem from this research. You will also serve a select group of clients, maintaining and developing relationships with key client stakeholders. This includes providing recurring metric reports to keep clients updated, primarily produced using SAS and a proprietary AS400 system.

You will be an integral part of recurring client meetings, requiring clear communication of technical information to non-technical audiences and leading conference calls when needed. The role empowers you to make decisions, think outside the box, and drive innovation within a rapidly expanding team.

Responsibilities

• Research, analyze, and correct rejected Medicaid encounters.
• Examine system setups, configurations, and text files to identify data integrity trends or issues.
• Develop and implement innovative solutions based on research findings.
• Maintain and develop relationships with key client stakeholders.
• Produce and deliver recurring metric reports using SAS and AS400.
• Communicate technical information clearly to non-technical audiences in both verbal and written formats.
• Lead conference calls and participate in recurring client meetings.
• Collaborate with a multi-functional team in a supportive, family-like environment.

Requirements

• 1+ years of professional work experience with data analysis.
• 2+ years of experience using Excel in a professional or academic setting.
• High school diploma or GED required; Bachelor’s degree preferred.

Preferred Qualifications

• 3+ years of professional work experience, preferably in data analysis or a related field.
• Previous Medicaid Encounter and/or PBM (Pharmacy Benefit Management) experience.
• 3+ years of advanced Excel experience.
• Strong problem-solving skills with the ability to work independently.
• Excellent communication skills for client interactions.

Skills

• Critical thinking and multitasking.
• Experience with SAS, AS400, or similar data analysis tools (advantageous).
• Ability to lead meetings and conference calls.
• Innovative mindset with a focus on creative solutions.

Pay

The typical pay range for this role is $46,988.00 - $122,400.00 annually. The actual base salary offer will depend on factors such as experience, education, and geography. This position is also eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

Benefits

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families, including:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources.

Schedule

• Full-time (40 hours per week).