CVS Health

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Encounters Project Lead

at CVS Health

Posted: 7/29/2020
Job Reference #: 71760BR

Job Description

Job Description
  • Accountable to assure encounter files for assigned state(s) are developed, prepared, submitted, logged, reconciled and errors corrected according to state/federal regulations.
  • Responsible for various mapping documents, report preparation and validation, inventory management and setting team priorities while executing toward department goals and metrics.

Fundamental Components
  • Assign tasks to team members based on inventory of internal and external rejects, issues, research and other deliverables
  • Project manage various tasks related to encounters for assigned state(s)/product(s) ranging from mapping documents, schedules and inventory management to production issue escalation
  • Work through other internal customers (i.e. Claims, CSSR, IT, Plan) to develop solution(s) for new requirements or configuration/setup that cause encounter rejects, perform root cause analysis
  • Work with external customers (i.e. state/federal regulator, software vendor, subcontracted vendors (i.e. dental, pharmacy, transportation, vision, etc.) to address requirements, rejects, issues, inventory management
  • Use health plan operations, claim processing, technical background to develop viable solution(s) to assure that complete and accurate encounter data is reported while eliminating encounter rejects and rework
  • Synthesize technical information or regulations to assure that encounter data for assigned state(s)/product(s) is compliant and error inventory is resolved
  • Lead or assist in requirements gathering/documentation, report preparation and/or validation, audit responses and request for proposal (RFP) support
Manage multiple competing priorities

Background Experience
  • 3-5 years of demonstrated leadership
  • 3-5 years of project management experience
  • 3-5 years of data interpretation and analysis experience
  • Excellent verbal/written communication skills
  • Understand technical requirements and convert to non-technical users
  • Effectively coordinate multiple projects simultaneously
  • Prior 837, 277, 824, NCPDP, 999 experience

Additional Job Information
Fast paced opportunity to lead various efforts to implement new plans, oversee and troubleshoot production issues for 837 encounter files, and assign work to various team members.
Coordinate meetings, prepare and update project plans, prepare communications to various internal and external customers.

Bachelor's degree or equivalent experience

Percent of Travel Required
0 - 10%

Business Overview
Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!