Lead Director, Infrastructure Capacity and Performance Management@ CVS Health

Job Information

Job Description:

Responsible for providing guidance and direction to external vendors, external consultants, team members and/or matrixed staff as required to support ACA IFP Risk Adjustment Revenue Integrity initiatives. Responsible for leading the reconciliation of data (coding review results and medical record images) from different sources, identifying gaps with in the process, and leading to develop more efficiency within the process.  Act as business lead for system design and in testing new functions, as well as, the support of auditing activities related to vendor reconciliation of coding results and medical record images as well as other technical projects.  Drive change related to enhancements and system fixes.  Understanding interdependencies both process wise and timing wise, to further business objectives.  To be successful, the candidate will use their knowledge and experience to create meaning from the data. This position also supports coordination across all shared services and vendors to assure data integrity and data validation processes are in place.  You will be responsible for auditing tasks including documenting and evaluating critical controls.  You will be responsible for understanding procedures, results and business impacts; and document and express such understanding in both written and verbal form.  Conducts periodic updates of analytical routines and department production systems. Investigates and evaluates alternative solutions to meeting business needs.
Support 1m IFP members through tightly managing vendor data quality and timeliness; ensure data is ingested into CREW to drive submissions; any and all CREW validation errors are worked timely to ensure submission completeness; analyse and understand digital retrieval to maximize results; customize ACA reporting views and outreach manager data needed for day to day operations work.

Required Qualifications

  • Must have experience with IT application development lifecycles, methodologies.
  • Experience influencing others by turning data into meaningful and actionable information
  • Experience with SAS/SAS EG/Python/SQL server in data analytics and manipulation
  • Attention to detail
  • Vendor management experience
  • Strong negotiation skills
  • Experience documenting business processes, as well as, recommending and implementing improvement strategies.
  • Ability to perform testing functions.
  • Participates in system design.
  • Ability to audit the accuracy of reporting against source documents/reports/databases.
  • Ability to implement auditing procedures
  • 5 or more years of healthcare, health insurance, or relevant combination of experience
  • Strong problem-solving, analytical, critical thinking and project management skills.
  • 10+ years experience with several of the following methodologies: management consulting, project consulting, business process consulting, financial strategic analysis strategic business planning, and/or risk management consulting.
  • Experience with CMS Risk Adjustment programs

Preferred Qualifications

  • See required qualifications


  • Bachelor’s degree in Mathematics, Economics, Statistics, Computer Science, Actuarial Science, Social Science, Healthcare or related discipline. or equivalent experience.

Experience Level: Senior
Work From: Onsite

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