Senior Manager, Compliance Business Manager-Network Management

CVS Health

71d • $67,900 - $199,144

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. This exciting role is a fast-paced healthcare provider support role, intended to foster a positive provider experience by supporting the end-to-end process of defining and supporting SOC and SOX controls through collaborating with cross-functional teams. This position will support network across all lines of business. Understanding the business to identify when a new control is required The facilitation of business process and control documentation, which includes writing new controls and ensuring controls are designed appropriately to manage risk Identify and proactively notify all impacted areas of control changes that may require enhancements, process changes or other updates Partner with stakeholders to continuously evaluate and recommend opportunities to reduce risk, strengthen the control environment, and introduce operational efficiencies Accountable for all steps within the life cycle of control testing including conducting walkthroughs with Internal and External auditors, maintaining Information Provided by Entity (IPE) and providing documentation as needed when audit selections are made Responsible for monthly and bi-annual control review, including audits of Provider Tab and Rate Wizard transactions, Fee Schedule and Rate Load Tracking Database audits Support audits out of QNXT and PRMS to support Medicaid SOC and SOX controls Coordinate with applicable reporting areas as needed to ensure reports are generated timely and are continuously reviewed for process efficiencies Must exhibit leadership qualities, strong communication skills, and strategic thinking Able to drive decisions based on data analysis May be asked to support other projects as needed based on business need.

Requirements

• 5+ years compliance and/or audit experience in SOC and SOX controls.
• 5+ years of project management experience.
• Experience in the health insurance industry.
• Strong communication, critical thinking, problem resolution, and interpersonal skills.
• Proven ability to influence and collaborate with providers and internal partners at all levels.

Nice To Haves

• Advanced working knowledge of business systems, applications, and tools supporting network management.
• Experience in related business environment with exposure to provider data and processes.
• Bachelor's degree preferred or specialized training/relevant professional qualifications.

Responsibilities

• Support the end-to-end process of defining and supporting SOC and SOX controls.
• Collaborate with cross-functional teams to foster a positive provider experience.
• Facilitate business process and control documentation.
• Write new controls and ensure they are designed appropriately to manage risk.
• Identify and notify impacted areas of control changes.
• Partner with stakeholders to evaluate and recommend opportunities to reduce risk.
• Accountable for all steps within the life cycle of control testing.
• Conduct walkthroughs with Internal and External auditors.
• Maintain Information Provided by Entity (IPE) and provide documentation for audits.
• Responsible for monthly and bi-annual control reviews.
• Support audits out of QNXT and PRMS for Medicaid SOC and SOX controls.
• Coordinate with reporting areas to ensure timely report generation.

Benefits

• Affordable medical plan options.
• 401(k) plan including matching company contributions.
• Employee stock purchase plan.
• No-cost wellness screenings, tobacco cessation, and weight management programs.
• Confidential counseling and financial coaching.
• Paid time off and flexible work schedules.
• Family leave and dependent care resources.
• Colleague assistance programs and tuition assistance.
• Retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree