CVS Health
Healthcare Compliance Senior Analyst
CVS Health, Woonsocket, Rhode Island, us, 02895
CVS Health Healthcare Compliance Senior Analyst Woonsocket, Rhode Island Apply Now
Bring your heart to CVS Health. Every 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. 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.Position SummaryAs a Healthcare Compliance Senior Analyst, you will ensure contractual and regulatory compliance as it relates to third party programs. You will act as a liaison between internal departments and external contacts such as health plans, processors, pharmacy benefit managers (PBM), and governmental agencies.Responsibilities:Third Party Information Management
Review communications distributed by PBMs, processors, health plans, state Medicaid and Medicare.Serve as a subject matter expert for internal and external representatives.Identify and resolve potential Third-Party operational issues.Understand Payer contracts and NCPDP Standards for compliance.Translate payer information and communicate to appropriate personnel.Compose articles for the Payer Relations Weekly Update and issue necessary communications.
Relationship Building
Maintain professional relationships with contracted agencies, PBMs, and health plans.Act as a problem-solving point of contact for payer complaints.Collaborate with payers and internal departments for process improvements.
Plan Code Facilitation
Evaluate third-party information for system updates.Track plan changes and prepare documentation for updates.
Team Work
Address prescription processing escalations from various departments.Contribute to a high-performing team and assist with policy implementation.
Our ideal candidate has excellent verbal and written communication skills, strong attention to detail, and the ability to problem-solve and multi-task.Required Qualifications3+ years of experience in the pharmacy industry with knowledge of standard contract terms and conditions.Preferred QualificationsKnowledge of Pharmacy Benefit Management is a plus.Bachelor's Degree preferred.Ability to think strategically and act tactically.Organized and detail-oriented with strong judgment.Self-starter with interpersonal and leadership skills.EducationHigh School Diploma or Equivalent work experience.Pay RangeThe typical pay range for this role is: $46,988.00 - $112,200.00.This position is eligible for a CVS Health bonus, commission or short-term incentive program. The Company offers a full range of medical, dental, and vision benefits.We anticipate the application window for this opening will close on: 10/31/2024.Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.We are an equal opportunity and affirmative action employer.
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Bring your heart to CVS Health. Every 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. 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.Position SummaryAs a Healthcare Compliance Senior Analyst, you will ensure contractual and regulatory compliance as it relates to third party programs. You will act as a liaison between internal departments and external contacts such as health plans, processors, pharmacy benefit managers (PBM), and governmental agencies.Responsibilities:Third Party Information Management
Review communications distributed by PBMs, processors, health plans, state Medicaid and Medicare.Serve as a subject matter expert for internal and external representatives.Identify and resolve potential Third-Party operational issues.Understand Payer contracts and NCPDP Standards for compliance.Translate payer information and communicate to appropriate personnel.Compose articles for the Payer Relations Weekly Update and issue necessary communications.
Relationship Building
Maintain professional relationships with contracted agencies, PBMs, and health plans.Act as a problem-solving point of contact for payer complaints.Collaborate with payers and internal departments for process improvements.
Plan Code Facilitation
Evaluate third-party information for system updates.Track plan changes and prepare documentation for updates.
Team Work
Address prescription processing escalations from various departments.Contribute to a high-performing team and assist with policy implementation.
Our ideal candidate has excellent verbal and written communication skills, strong attention to detail, and the ability to problem-solve and multi-task.Required Qualifications3+ years of experience in the pharmacy industry with knowledge of standard contract terms and conditions.Preferred QualificationsKnowledge of Pharmacy Benefit Management is a plus.Bachelor's Degree preferred.Ability to think strategically and act tactically.Organized and detail-oriented with strong judgment.Self-starter with interpersonal and leadership skills.EducationHigh School Diploma or Equivalent work experience.Pay RangeThe typical pay range for this role is: $46,988.00 - $112,200.00.This position is eligible for a CVS Health bonus, commission or short-term incentive program. The Company offers a full range of medical, dental, and vision benefits.We anticipate the application window for this opening will close on: 10/31/2024.Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.We are an equal opportunity and affirmative action employer.
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