Compliance Manager

CVS Health • Irving, TX

4d

About The Position

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary: As a Compliance Manager, you will oversee All Payer Claims Database (APCD) states. This role is critical in ensuring that our organization adheres to all regulatory requirements while effectively managing high risk areas. You will be responsible for overseeing the handling of vendor and regulator requests as related to laws, bulletins and other requests. In addition, you will be responsible for the timely delivery of all file types, responses to inquiries, setting timelines for new APCDs, writing requirements for all systems and affiliates. Will also be responsible for mentoring and training within the team as well as across organizational lines. Creating reports for management, identifying issues, communicating findings and potential resolutions with both management and IT teams.

Requirements

• Minimum 5 years of experience in Compliance/Legal in healthcare, insurance or financial services setting
• Minimum 5 years of knowledge of all types of health care products including HMO, PPO, Medicare Advantage and Medicare Part D
• Minimum 2 years of knowledge of all types of pharmacy products including specialty drug, Medicare Part D and understanding of PBM operations
• Ability to travel up to 10% (including plane)

Nice To Haves

• 4-6 years of data interpretation and analysis experience.
• 5-8 years of experience in technology – SAS, SQL, ACL, Excel, Other database tools, Microsoft Office Suite
• Extensive experience with databases as well interpretation and manipulation of related data
• 8+ years of healthcare background – ability to review and interpret State/Federal regulations/legislation and create business requirements.
• 3-5 years of experience in project management and process redesign
• 3+ years Compliance related functions including contact with regulatory bodies
• Strong organizational skills - ability to manage multiple projects, tasks and deliverables simultaneously, reprioritizing as needed.
• Strong written and verbal skills - ability to request and interpret complex information and to communicate within CVS Health and with external business partners.
• Ability To: Influence change or enhancements to business processes, policies, and system infrastructure to improve information quality, availability, and access.
• Driving enhancements and data quality processes to ensure compliance with state/Vendor guidelines.
• Analyze data quality for trends, highlights in-depth interpretations, and provides in-depth root cause analysis.
• Understanding of how healthcare claims are billed and understanding of how industry codes work together

Responsibilities

• Running/reviewing/setting up simple to complex projects end to end, Including setting up timelines, requesting extensions, communicating with regulators.
• Translating regulations into business requirements, both complex and simple, across all facets of the company.
• Using automated tools and reports as well as non-automated tools.
• Research and investigates issues identified both internally and by our customers.
• Identifying possible system issues and assists with correction of the issues identified.
• Writing complex business requirements based on findings to ensure a successful correction of issues identified.
• Utilizing knowledge of data sources, systems, products to influence changes in processes in place to streamline and automate as much as possible.
• Mentors/Trains/Coaches within 1:1 environment or broadly in group settings with all levels either voluntarily or when sought by others.
• Provides technical support for tools used in the department.
• Creation of training material for department.
• Builds strong teams within the APCD team, across other teams to optimize results and staff utilization.
• Effectively communicates verbally and in writing using language suitable to audience.
• Effectively communicate negative news to regulators whether in writing, verbally or in person.
• Effectively communicate with PBM account managers and clients, setting expectations and timelines.
• Escalate issues to business partners and senior team members
• Create and maintain process documents, ensure proper record of submission, documentation of actions taken, documentation of files reported, status of files and other work-related tasks.
• Maintains appropriate documentation on reporting requirements for assigned states, writes/updates Policies and Procedures for the team

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees