Mgr, Project Management (IC)

CVS Health; Hartford (CT); Remote; USD 54,300 - 159,120; Full time

Benefits offered by this job

Bonus eligibility

Commission program

Job summary

A leading health solutions company is seeking a Product Owner for the provider digital experience in Hartford, Connecticut. This role involves overseeing encounter submissions and ensuring data quality, while collaborating with various stakeholders. The ideal candidate has 3-5 years of relevant experience and a strong background in provider electronic transactions. The position offers a competitive salary range from $54,300 to $159,120, and is a full-time, remote role.

Qualifications

• 3-5 years’ experience related to duties or equivalent education and work experience.
• Very strong interpersonal and relationship management skills.
• Ability to drive resolution across stakeholders.

Responsibilities

• Collaborates with teams to diagnose issues and maintain efficient processes.
• Supports implementation of encounter transactions and provides training.
• Monitors metrics and uses insights for business decisions.

Skills

Advanced knowledge of provider electronic transactions

Strong organizational skills

Interpersonal skills

Project leadership experience

Education

Bachelor's degree or equivalent experience

Tools

Excel

MS Office applications

SQL

Power BI

Tableau

Job description

Overview

CVS Health is a leading health solutions company delivering care where, when and how members choose. The position described is a Product Owner of the provider digital experience focusing on the Encounter transaction, owning encounter submission and end-to-end processing to support risk revenue and services data for members. The role collaborates with claim Clearinghouses and internal teams (e.g., Network Management, system Product Owners) to troubleshoot issues and ensure smooth end-to-end processing across Commercial and Medicare lines. The role uses data analytics to monitor encounter health, researches and manages issues, participates in strategy development, and works to ensure encounter completeness, data quality, and vendor accountability.

Responsibilities

• Collaborates with Provider eSolutions and across business areas (e.g., Provider Data Maintenance, Network Management) to diagnose issues, deploy solutions, and maintain efficient business processes.
• Supports end-to-end implementation of encounter transactions and provides necessary training for providers and transaction vendors.
• Ensures onboarding of new entities to ensure successful encounter data submission.
• Maintains collaborative working relationships with external vendors and capitated physician groups, IPAs, PHOs and hospital systems.
• Partners with contracted vendors and capitated physician groups, IPAs and hospital systems to measure encounter performance and improve encounter data quality.
• Ensures appropriate vendor linkages are established and maintained to facilitate provider utilization of system applications.
• Monitors metrics, analyzes data, and uses insights to inform business decisions and strategy.
• Participates in cross-functional projects and process improvements to strengthen encounter operations and support business objectives.
• Supports policy and regulatory compliance related to provider electronic transactions.

Required Qualifications

• 3-5 years’ experience directly related to the duties and responsibilities, or an equivalent combination of education and work experience.
• Advanced knowledge of provider electronic transactions.
• Strong organizational skills and ability to drive resolution across internal and external stakeholders.
• Comfortable navigating ambiguity and evolving processes.
• Very strong interpersonal, relationship management, writing and presentation skills.
• Proven project leadership experience.
• Ability to use Excel and comfort with MS Office applications; intermediate to advanced proficiency in Excel.
• Familiarity with Provider electronic transactions.

Preferred Qualifications

• Experience with 837 formatting or provider electronic transactions.
• Network Management experience a plus.
• Capitation and Delegation knowledge, including impact on provider contracts and encounter submissions, preferred.
• Strong working knowledge of systems such as EPDB, ACAS, EWM, HRP; familiarity with EDI and Microsoft SharePoint/Word/Excel.
• Familiarity with APLC – Agile and Waterfall; experience with tools like Excel, SQL, Power BI or Tableau.
• Proven track record meeting project dates and coordinating multiple projects simultaneously.
• Excellent communication skills, both written and verbal; ability to manage multiple priorities.
• Strong understanding of the healthcare industry and regulatory environment and the ability to turn data into information.

Education

Bachelor's degree or equivalent experience

Additional Information

• Remote role does not support sponsorship at this time.
• Anticipated Weekly Hours: 40
• Time Type: Full time
• Pay Range: The Typical Pay Range For This Role Is $54,300.00 - $159,120.00. The actual base salary offer depends on factors including experience, education, geography and other relevant factors. This position may be eligible for a CVS Health bonus, commission or short-term incentive program in addition to base pay.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.