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About the Role
CVS Health Third-Party Revenue Cycle Management (RCM) is seeking an Insurance AR Resolution Analyst to perform advanced, payer-level analysis. This role supports Third Party Account Management in maximizing collections, reducing bad debt, and ensuring compliance. The analyst will identify systemic drivers of payer exceptions, overpayments, liabilities, and remittance issues through trend analysis and root cause diagnosis, producing insights and recommendations for operational improvements.
Responsibilities
- Perform advanced, payer-level analysis to support Third Party Account Management.
- Maximize collections, reduce bad debt, and ensure compliance with federal, state, and CVS Health requirements.
- Identify systemic drivers of payer exceptions, overpayments, liabilities, and remittance issues through trend analysis, root cause diagnosis, and data validation.
- Produce clear, leadership-ready insights and recommendations that drive short- and long-term operational improvements.
- Coordinate files for write offs.
- Work closely with system partners by attending requirement meetings, identifying and reporting defects, and following up on resolutions.
- Recommend and write requests to streamline current processes.
- Apply advanced analytical and statistical techniques to identify root causes of Third-Party payer issues.
- Validate data accuracy and completeness using SQL and internal reporting tools.
- Translate complex findings into clear, actionable recommendations for leadership.
- Collaborate cross-functionally to prevent recurrence of payer issues.
- Maintain regular and predictable attendance.
- Perform additional duties within role scope.
Requirements
- Knowledge of Third Party Revenue Cycle operations, payer behavior, and liability resolution.
- Knowledge of Commercial and Medicaid payer environments.
- Advanced analytical and root cause diagnosis techniques.
- Solid working knowledge of all MS Operating Systems and MS Office applications (MS Word, Excel, Access, PowerPoint), and process mapping software such as Microsoft Project and Visio.
- Proficiency in SQL and data-mining tools to validate and reconcile financial data.
- Familiarity with MicroStrategy, SQL, and other data mining tools.
- Ability to develop leadership-ready documentation and recommendations.
- Ability to independently evaluate complex problems and recommend effective solutions.
- Ability to influence decisions through data-driven insights.
- Ability to prioritize and organize work to accurately complete projects or assignments on schedule.
- Ability to work individually or with a team to systematically identify and define problems, evaluate alternatives and implement practical, cost-effective solutions.
- Ability to frame recommendations and formally present them to management.
- Ability to work with sensitive financial and patient data in compliance with HIPAA.
- Ability to maintain composure and perform job duties/responsibilities when confronted with stressful situations.
- Ability to maintain excellent verbal and written communication skills and the ability to interact professionally with a diverse group.
- Ability to work in strict confidence, always ensuring the confidentiality of the patient and medical and financial records, in compliance with company and HIPAA Privacy guidelines.
- Ability to operate effectively in ambiguous or evolving environments.
- Accounts receivable or payer-facing experience.
- Experience supporting system enhancements or process improvement initiatives.
- Strong presentation and stakeholder communication skills.
Skills
- SQL
- MS Office applications (MS Word, Excel, Access, PowerPoint)
- Process mapping software (Microsoft Project, Visio)
- Data mining
- MicroStrategy
- Analytical thinking
- Root cause diagnosis
- Data validation
- Data reconciliation
- Documentation
- Presentation
- Stakeholder communication
Location
- Remote
Work Type
- Full-time
Experience Level
- 3 to 5 years of analytics experience (Preferred)
- 2+ years required
Education Level
- High School Diploma or General Equivalent Development (GED) (Required)
- Bachelor Degree (Preferred)
Salary/Compensations
- $43,888.00 - $102,081.00
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
About the Company
- CVS Health is building a world of health around every individual, shaping a more connected, convenient, and compassionate health experience.
- Colleagues are passionate, innovative, accountable, and prioritize safety and quality.
- The company aims to simplify health care one person, one family, and one community at a time.
Equal Opportunity
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.