Informatics Consultant

We are seeking a detail-oriented organized individual to join the Individual and Family Plans (IFP) Informatics team. This role will provide analytical support to IFP and market leadership to ensure the accuracy reporting and maximize the opportunities of Risk Adjustment programs at CVS/Aetna.

Leads the analytic solutions and reporting to key stakeholders across ACA program and market leaders. Interact and collaborate with ACA submission, vendor management, compliance, and actuary team to track ACA Risk Adjustment score trend and intervention program results. Act as analytic team lead to ensure timely delivery of key projects supporting VBC performance initiatives.

• Working knowledge of applying HHS ACA Risk Adjustment Methodology, Adult/Child/Infant model, HCC Hierarchy.
• Performs analytics through querying medical, Rx, lab claims to identify high risk gap members.
• Collaborate with Actuary teams to track market/HIOS level risk score trends. Provide forecast and Wakely data comparison to market leaders
• Experience in prospective and retrospective intervention programs, working knowledge of Care Management program and how to close documentation gaps.
• Familiar with HHS RADV program and provide analytical support for RADV audits
• Familiar with membership attribution, VBC provider arrangements and facilitate VBC performance analytics.
• Research and provide analytical insights to optimize intervention programs performance.
• Conduct Revenue Cycle Analysis on intervention programs. Working with Actuary team to generate revenue reports to leadership team
• Develop visualization dashboards and meet with business clients regularly to communicate, drive and create actionable impacts

Pay Range

The typical pay range for this role is:

Minimum: 60,300

Maximum: 130,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

• 5 years of data manipulation/analysis experience (can include internships)
• 2 years of experience with SAS, SQL Server and other DB language

Preferred Qualifications

Experience with Exchange/Medicare/Medicaid Risk Adjustment a plus

Experience with Tableau or other data visualization tools preferred

Excellent verbal and written communication skills

Education

Bachelor's degree or equivalent work experience

Business Overview

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. 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.