CVS Health

Woonsocket, Rhode Island, United States

Medicare EDI Senior Consultant

Posted over 1 month ago

Job Description

Job Description
Position Summary/Mission

Provides consultation on the requirements, testing and enhancement of Medicare Claim Intake data including technical assistance and product development support to internal customers.

Researches, manipulates and prepares complex data to document program activities and reports on its results.

Provides oversight to data quality and provides feedback to various areas to improve claim adjudication and enhancement to design efforts.

Develops a consultative relationship with internal customers.

Fundamental Components & Physical Requirements

May lead or act as a business technical expert with the planning, development and validation of master or detail test plans and strategies.

Performs ongoing research, and support tasks for existing systems.

Leads or acts as a business technical expert in the design of new applications or enhancements including integration of solutions.

Directs the implementation of program specific information through education, technology, organizational methods and procedures.

Influences enhancements to business processes and system infrastructure to improve data quality availability and access.

Analyzes complex data for trends, highlights in-depth interpretations and provides in-depth root cause analysis.

Analyzes and enhances existing EDI processes by collaborating with technical and/or business resources in troubleshooting application issues and supported business activities.

Defines, identifies, develops and implements information products to support strategic business and operational planning.

Illustrates complex information in a clear concise manner.

Provides workgroup support on projects.

Influences changes/enhancements to business processes, policies, and system infrastructure to improve information quality, availability and access.

Evaluates available software and data to deliver better business solutions.

Required Qualifications
Minimum 3 years experience in Medicare Claim environment.

Applicants must have documented Medicare EDI knowledge in order to be considered.

Thorough knowledge of EDI transactions including 837P/I, 835, 834, TA1, 999, 277CA, 276/277 and 270/271.

Technical and non-technical troubleshooting skills with ability to diagnose and resolve problems efficiently and effectively.

Excellent verbal and written communication skills.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
PMP / Six Sigma Certification.

Bachelors degree, technical certification or equivalent work experience.

Business Overview
At 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.