Medicaid Provider Data & Attribution Governance Lead

CVS Health; Tallahassee (FL); On-site; USD 68,000 - 199,000; Full time

Job summary

CVS Health leads provider data governance and attribution for Medicaid operations, coordinating with provider relations, IT, analytics, claims, and other teams to ensure accurate data reflected across downstream systems.

The role emphasizes governance, audit readiness, and process improvements to reduce rework, with a focus on regulatory compliance and customer experience. A Bachelor's degree or equivalent experience is required, with strong analytical tool skills and communication ability.

Qualifications

• 7-10 years of experience in health care operations or data governance.
• 5+ years in Medicaid, managed care, provider data, or healthcare analytics.
• Experience with SQL, advanced Excel, Power BI, Tableau, or comparable analytical tools.
• Ability to investigate, analyze, and reconcile complex health care data, identify root causes, and recommend corrective actions.
• Experience coordinating cross-functional issue resolution and operational improvements.
• Strong communication skills to translate operational issues into clear business risk, action plans, and ownership.

Responsibilities

• Lead attribution, membership, and provider data governance processes to ensure accurate and reliable outputs.
• Oversee resolution of provider data and attribution issues affecting member assignment and downstream operations.
• Partner with health plan leaders, network teams, provider data, claims, compliance, marketing, operations, and technology partners to deliver projects that support performance, regulatory requirements, and customer experience.
• Support provider directory accuracy, audit readiness, and regulatory validation through monitoring, documentation, and remediation of issues.
• Identify recurring defects, root causes, and control gaps; drive process improvements to reduce rework and improve reliability.
• Maintain governance routines, process documentation, and cross-functional coordination for attribution and provider data operations.

Skills

Healthcare data governance

Medicaid operations

Data analysis

Cross-functional collaboration

Communications

Root cause analysis

Problem solving

Education

Bachelor's degree or equivalent professional experience

Tools

SQL

Advanced Excel

Power BI

Tableau

QNXT

MDW (Medicaid Data Warehouse)

Job description

CVS Health leads provider data governance and attribution for Medicaid operations, coordinating with provider relations, IT, analytics, claims, and other teams to ensure accurate data reflected across downstream systems.

The role emphasizes governance, audit readiness, and process improvements to reduce rework, with a focus on regulatory compliance and customer experience. A Bachelor's degree or equivalent experience is required, with strong analytical tool skills and communication ability.