Vacancy expired!
Job DescriptionServes as subject matter expert for the risk assessment of all Medicare Advantage activities and programs across the market under the RISK Director-Provides guidance and consultation for provider design and regulatory compliance-Provides support for the DSNP and Medicare Advantage operational interface to ensure tactical business goals are achieved across the organization-Assists with the execution of CMS required activities and processes including the accuracy and compliance of the annual bid application, expansion application, member materials, and group setup.-May participate on various committees to represent the Medicare Department-Designs enterprise wide and/or cross-functional solutions to address business problems.-Partners with business owners to optimize the achievement of strategic business objectives, to include profitable growth and improved organizational effectiveness.-Maintains trending data for multiple providers at market level to gauge risk adjustment improvement efforts.-Knowledge of payer submission sourcesPay RangeThe typical pay range for this role is:Minimum: 60,300Maximum: 126,600Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications3+ years experience in Medicare operations and/or Medicare compliance in a payer setting- Experience with financial measurement and impact plans-Ability to effectively coordinate multiple projects and programs in a matrix environment and work independently-Familiarity with regulations and statues impacting Medicare Advantage-Highly Proficiency with Microsoft applications including MS Word, Excel, Outlook and PowerPoint-Excellent communication, interpersonal, and presentation skills-Risk Adjustment HCC experience
COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsLive in WA, ID, ORSQL coding experienceEducationCollege Degree or 7 years of relevant experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Vacancy expired!