Head of Provider Data Operations & Attribution Integrity

CVS Health; Charleston (WV); Presencial; USD 90.000 - 130.000; Jornada completa

Descripción de la vacante

CVS Health in Charleston, WV seeks a Senior Manager to lead attribution, provider data governance, and related operational controls for Medicaid scalability and accuracy.

The role collaborates with provider data, IT, analytics, and claims teams to ensure data integrity, regulatory compliance, and robust customer experience. A Bachelor’s degree and 5+ years in relevant fields are expected.

Formación

• Five+ years of experience in Medicaid, managed care operations, provider data, healthcare analytics.
• Experience with SQL, Excel, Power BI, Tableau, or similar analytical tools.
• Ability to independently investigate, analyze, and reconcile complex health care data, identify root causes, and recommend actions.
• Experience resolving provider data issues including identifiers, affiliations, contracts, etc.
• Strong communication to translate operational issues into business risks and actions.
• Experience managing provider attribution methodologies, governance, reporting, and execution.
• Experience using QNXT and MDW data for decision-making and issue resolution.
• Experience managing provider rosters and directory data across teams.

Responsabilidades

• Lead attribution, membership, and provider data governance to ensure accurate outputs.
• Oversee resolution of provider data and attribution issues impacting member assignment and downstream ops.
• Partner with plan, network, data, claims, compliance, marketing, and tech teams on projects.
• Support provider directory accuracy, audits, and regulatory validation activities.
• Identify recurring defects, root causes, and control gaps; drive process improvements.
• Maintain governance routines and cross-functional coordination for attribution and provider data ops.

Conocimientos

Medicaid operations

Data analysis

Cross-functional collaboration

Communication skills

Leadership

Educación

Bachelor's degree or equivalent

Herramientas

SQL

Excel

Power BI

Tableau

QNXT

MDW

Descripción del empleo

CVS Health in Charleston, WV seeks a Senior Manager to lead attribution, provider data governance, and related operational controls for Medicaid scalability and accuracy.

The role collaborates with provider data, IT, analytics, and claims teams to ensure data integrity, regulatory compliance, and robust customer experience. A Bachelor’s degree and 5+ years in relevant fields are expected.