Senior Manager, Provider Documentation Audit

CVS Health

9d • Hybrid

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. At Aetna®, part of CVS Health, we proudly serve more than 26 million medical members through our broad range of health plan offerings. We're committed to delivering a simpler, more meaningful, and personal health care experience to each of them. As a Senior Manager, Provider Documentation Audit, you will play a critical role in supporting our Aetna members and our business by managing a production team that supports network growth initiatives through audit of provider application documentation. You will track and document quality and productivity metrics, providing actionable insights and performance data to support management decisions and training program development.

Requirements

• 7+ years of experience in health insurance industry, preferably in a role related to network, provider, or payer operations
• Experience collaborating with business partners to successfully implement large organization initiatives
• Experience applying data and analytical insights to drive informed business outcomes, tell a story and provide leadership level insights
• Experience leading teams in a high production, deadline driven environment

Nice To Haves

• 2-3 years Project management experience
• Demonstrated experience leveraging tools including QuickBase, Excel (pivot tables, basic formulas), and SharePoint to support data analysis and workflow collaboration
• Excellent verbal and written communication skills, with experience creating clear, impactful presentations in PowerPoint
• Medicaid experience

Responsibilities

• Oversee and manage the end-to-end delivery of accurate and complete required documentation for network growth initiatives, including document intake, audit review and approval process and tracking and documentation
• Drive collaboration cross-functionally to support network growth initiatives.
• Offer expert guidance on provider application requirements, conducts audits to ensure data integrity, and initiates or supports remediation efforts as needed to maintain high standards of operational excellence.
• Project management oversight, process improvement and documentation development and maintenance.
• Develop and maintain key performance indicators for team production, designs and regularly presents timely and transparent performance reporting to leadership with proactive identification of risks and appropriate mitigation plans
• Identify and mitigate risks, escalating issues promptly and proposing effective solutions to overcome project challenges
• Coordinate with cross-functional implementation team, collaborates effectively with network partners and health plan SMEs to meet implementation initiative needs
• Work closely with leadership & business stakeholders to secure new implementation planning approval, funding/resource alignment and initiate execution plans
• Manage pipeline of new implementation initiatives and overseeing the evaluation of multiple requests at any given time
• Manage multiple concurrent reporting initiatives with critical deadlines, while working within established processes and identifying improvement opportunities
• Ensure intake, audit and tracking standards are followed
• Cultivate and manage relationships with various internal business partners
• Exercise sound judgment and critical thinking skills, demonstrates analytical/problem-solving skills
• Assess organizational needs to optimally build a functional team through formal training, diverse assignments, communication, coaching, mentoring and performance management accountable for hiring and developing staff members.
• Manage operational aspects of the team (e.g., budget, performance, and compliance), and implements workforce and succession plans to meet business needs.

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: Senior
• Number of Employees: 5,001-10,000 employees