Senior Manager Project Management Strategic Pricer

CVS Health•Hartford, CT

About The Position

We are excited to invite a highly motivated and detail-oriented Sr. Manager Project Management to join our team. The Sr. Manager will be part of the Network Platform Solutions – Contracts & Pricing Team, leading the Strategic Pricer team to support Strategic Pricer projects. In this role, you will perform and oversee multiple functions pertaining to Strategic Pricer functionality and enhancements for participating providers. This position offers a valuable opportunity for personal and professional growth, as you will play a key role in successfully delivering and executing enhancements while collaborating with various business partners.

Requirements

5+ years project management experience
5+ years ACAS participating provider claims processing experience
5-7 years healthcare insurance experience
Full understanding of the SCM rate wizard input, non-preferred contracting options, Carve Out & Grouper tabs
Familiar with Professional Component concept, and EPDB limitations related to same
Moderate understanding of EPDB & SCSR: Provider & PBG selection logic; fee schedule & modifier pricing logic
Demonstrated strong understanding of Strategic Pricer logic and concepts
Excellent verbal and written communication skills

Nice To Haves

BIR/Provider Solutions background
Network Contracting and/or SCM Contracting support experience
Familiarity with the various CMS payment methodologies supported by Strategic Pricer via Burgess software
QuickBase and SharePoint user experience

Responsibilities

Oversee a team responsible for researching and analyzing Strategic Pricing system functionality and enhancements.
Delineate any other interfacing or manual manipulation altering the price.
Validate theory when claim reports are furnished from other business areas.
Support the analysis of Aetna’s contract rate tools (SCM Web) to identify operational improvement opportunities/validate a financial comment is needed, including walk through of the entry guidance when changes are warranted.
Think critically, applying mastery pricing concepts to predict pricing outcomes.
Provide project support which entails assessing risks both up & down stream, formulating business requirements, working in partnership with our IT counterparts, assembling testing strategies, validating testing results, including review and sign-off during code implementation.
Formulate training techniques, create training materials, and facilitate in partnership with other systems.
Contribute to maintenance/ update of all team training materials, including formulation of contract/claim examples, system mock-ups, and depiction of pricing outcomes.
Explain complex concepts in laymen's terms, as well as furnish visual representations of the concepts.
Coordinate with various service grouping content owners, analyze code sets, implement maintenance requests, then audit for accuracy for Standard Contracted (CNT) and IPA/DOFR (Independent Physician Association/Division of Financial Responsibility) Service Grouping Maintenance and related Billing Code Rules -- at least on a quarterly basis.
Evaluate Provider Network requests for new business, as well as conduct comprehensive provider contract analyses prior to renewal or renegotiation, including facilitation of network contract analysis meetings, ensuring thorough compliance with Policies 239 and 264.
Serve as a subject matter expert for Strategic Pricer.
Evaluate combinations of rate drivers and payment methods in the Rate Wizard applying Strategic Pricer concepts, to predict outcomes.
Research and analyze claim inquiries regarding accuracy of Strategic Pricer and/or identify contract input errors.
Support other business initiatives and system projects as required.
Collaborate with cross-functional teams to ensure effective implementation of project objectives.
Monitor project progress and report on key metrics.
Facilitate meetings and discussions to gather feedback and drive project improvements.