Senior Analyst, EDI Investigation (Fully Remote)

Company: CVS Pharmacy
Location: Hartford
Posted on: March 18, 2023

Job Description:

Job DescriptionThis position can be Work From Home anywhere in the United States. Join the Provider Digital Enablement organization as a Senior Analyst within the Provider EDI Investigation team. This role is responsible for investigating provider EDI inquiries. You will be engaged with both internal and external customers with electronic transaction issues such as Eligibility & Benefit Inquiry; Claim Status Inquiry; Authorization Add, Inquiry and Notification; Electronic Attachments; Electronic Funds Transfer, Electronic Remittance Advice and online EOBs. Triage, investigate and track internal inquiries related to electronic solutions. Respond to inquires regarding issues with electronic transactions with the correct TAT. Identify issues and escalate to IT to review and correct. Follow up on ongoing issues with provider offices to ensure members are getting the services they require. Maintain collaborative working relationships with external vendors, providers and applicable 3rd parties. Responsible for participation in portions of projects representing the provider interest in all transactions. Collaborate across Aetna business areas (including, but not limited to, Provider Data Maintenance; Transaction Management; Portal Operations; Learning and Performance; Network Management; Clinical Operations) to effectively execute business operations. Identify emerging patterns resulting from analysis. Provide solutions and implement change to improve efficiencies, gaps or issues. May serve as a Subject Matter Expert on electronic transactions.Required Qualifications 3+ years working with healthcare providersCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Familiarity with:- EDI (Electronic Data Interchange) transactions and digital tools- Microsoft Office suite, QuickBase, SharePoint, Teams; service mailboxes and salesforce. - Working knowledge of claims processing, referrals and authorizations (precert).Education Bachelor's degree or equivalent experienceBusiness OverviewBring your heart to CVS HealthEvery 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.

Keywords: CVS Pharmacy, Hartford , Senior Analyst, EDI Investigation (Fully Remote), Professions , Hartford, Connecticut