Hybrid Senior Manager, Provider Documentation Audit

at CVS Health

• Job title: Senior Manager, Provider Documentation Audit
• Job type: Full Time
• Experience level: Senior
• Salary: $67,900 - $149,328 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Work from home, United States

About the role

• Senior Manager overseeing provider documentation audits for Aetna, managing teams and improving operational excellence. Driving network growth initiatives through data integrity and project management.

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.

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
• 2-3 years Project management experience (preferred)
• 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 (preferred)

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs including wellness screenings, tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access