Job Information
CVS Health Senior Analyst, Specialty Medical Prior Authorizations in Austin, Texas
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. 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.
Position Summary
Available shift: 8:00 AM - 5:00 PM Central Standard Time (CST), Monday through Friday.
The Senior Analyst will act as the Prior Authorization system Subject Matter Expert to provide support for the Medical Prior Authorization/Appeals Operational teams. Primary responsibilities include: Lead projects related to PA system enhancements, configuration changes, and processes to increase departmental cost savings and efficiencies; Perform testing and validation of presented system UAT test plans; Lead discussions to obtain feedback from user groups and work with IT and the business to develop and deploy system enhancements. Additional responsibilities include: Collaborate with multiple cross-functional partners such as Operations, Legal, and IT Teams to identify and implement system enhancements and projects within the Prior Authorization system meeting both state and federal requirements; Collaborate with CAS/NLX PA Ops Liaisons, Product/Account teams, and clients for: new client implementations, client, state or regulatory implementations, direct client support when needed.
The Sr. Analyst is also responsible for ensuring that the day to day operational processes follow the applicable regulations of ERISA, NCQA, URAC, and other Federal/State requirements and makes decisions to align/change our processes with the requirements. Sr. Analyst will also work with a team of trainers to: Assist in documentation and maintenance of work instructions, job aids, user guides and presentations; Provide system demos and help guide NLX users through the implementation process for Prior Authorization; Collaborate with the leadership team to assist with planning and development concerning employees; Apply innovative thoughts and derive new strategy to implement new product ideas; Collaborate with the leadership team to assist, research, and document Corrective Action Plans and Service Warranties.
Additional responsibilities to include but not limited to the following:
Develops and maintains data reporting systems and dashboards to monitor key performance indicators (KPIs) related to clinical services, such as patient outcomes, quality of care, and operational efficiency.
Implements performance monitoring systems to track and evaluate the effectiveness of clinical services.
Identifies trends and patterns in the data sets and recommends strategies to improve clinical service delivery and outcomes.
Develops and implements strategies to streamline workflows, reduce wait times, improve patient flow, and enhance operational efficiency.
Defines project goals, develops project plans, and coordinates resources to ensure successful project execution.
Communicates with clinical leadership to develop and disseminate guidelines, protocols, and best practices that ensure standardized and high-quality care delivery.
Under limited supervision, collaborates effectively with interdisciplinary teams, providing subject matter expertise and guidance on clinical services analytics.
Encourages team members to explore innovative solutions and approaches to operational challenges.
Analyzes opportunities of areas of concern and recommends corrective actions for team advancement and development.
Develop work instructions for the team
- Assist with Regulatory reporting and provide operational audit support
Required Qualifications
4 plus years work experience in Prior Authorizations and/ or Appeals activities preferred.
Proficiency with Excel, Word, and Powerpoint.
Past experience conducting presentations
Ability to meet strict deadlines.
Preferred Qualifications
Project Management
- Current or previous PA system setup experience preferred
Strong knowledge of salesforce
Proven capability to work with people at all levels of an organization
Exceptional communication skills (oral and written).
Self directed with proven ability to manage and prioritize multiple projects simultaneously and meet deadlines.
Energetic and highly motivated to provide exceptional client support and service
Education
Bachelor ’s Degree or Equivalent Work Experience
Pay Range
The typical pay range for this role is:
$43,700.00 - $102,000.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
We anticipate the application window for this opening will close on: 06/07/2024
We are an equal opportunity and affirmative action employer. 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.