A team leader who manages processes and projects to support the quality, integrity, and transparency of data flowing through the Accordant data warehouse (includes EPIC) and Medical Opportunity Analysis SAS Environment. Ensures timely and thorough data review of incoming client files, implementation extracts, ad hoc datasets, and EPIC data. Responsible for maintenance and evolution of methodologies and models used for automated and manual QA. Leads projects and initiatives to establish a standard data model, and best practices for data flow and interpretation. Facilitates tracking, communication, escalation, and triaging of claims and eligibility data issues that arise. Responsibilities include serving as a lead resource and mentor on a team of analysts, with goals of scaling and automating QA in order to serve downstream business needs (reporting, recon/outcomes, and book of business) in support of existing and prospective CVS Health and Accordant clients. PRIMARY DUTIES AND RESPONSIBILITIES: List the top four or five primary responsibilities of the position in the space provided below, indicating the most important functions first and the approximate percentage of time spent on each.
Responsibilities % Time
1. Oversees projects and processes that assure timely and effective sign off on monthly incremental claims and eligibility files for all Accordant and Medical OA clients, though automated process design and facilitating work across junior staff members. Supports efficient and comprehensive QA/sign off on implementation extracts and ad hoc datasets. Responsible for EPIC data support, and IT ticket submission and prioritization. 35%
2. Leads projects to assure Accordant and Medical OA data standardization (enforce standard data model), data consistency across clients, and issue/nuance transparency. Advocates for data quality and integrity, while enhancing process efficiencies. Maintains library of data layouts for client data requests, and recommends/advocates for best approach to receive ongoing data. 30%
3. Effectively communicates process, prioritization, and analytic findings to downstream customers and other relevant audiences. Creative problem solving, to minimize risk of data issues while supporting client timeline needs. Supports IT ticket submission and prioritization. 20%
4. Supports development of a highly skilled team of analytic professionals, including developing processes to support analytic development activities. Mentors team members and supporting their career path. 10%
5. Supports broader company efforts around warehouse data integrity, quality assurance, standardization, and integration – including EPIC-related initiatives. 5%
In order of importance, list specific skills or talents that a qualified incumbent should possess (i.e., management of large staff, computer applications, subject knowledge, etc.)
• Strong experience leading analytical data projects across functional teams, including coaching and feedback of other team members on analytic approaches;
• Experience with data manipulation with SAS and retrieving data from large databases with SQL, or similar data access, manipulations and statistical analysis tools;
• Experience analyzing and manipulating medical claims, pharmacy claims, and eligibility data
• Experience developing, implementing, testing and maintaining automated and manual QA processes
• Experience loading and transforming (ETL) varied external claims and eligibility extracts, to standard data model
• Experience in maintaining and enhancing templates, models, algorithms, methodologies, and assumptions
• Excellent problem solving skills and ability to construct analytic solutions to business problems;
• Excellent written and oral communication skills, ability to interact with and influence decision-making by non-analytical business audiences;
• Strengths in data issue root cause analysis, with accountability over resolution development and execution
• Background in supporting transfers of large data files from external sources, adhering to legal guidelines for handing sensitive healthcare data
Master's degree with 7 years of Related work experience or Bachelor's degree with 10 years of related work experience required.
Other Certificates or Licenses (List)
Advanced degree in Business, Informatics, Information Technology, Computer Science, or HealthCare Administration preferred.
It's a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. As a CVS Health colleague, you'll be at the center of it all.
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.
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