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CVS Health · 3 months ago

Healthcare Analytics Business Consultant (SQL / Python)

United States

Full-time

Remote

Mid, Senior Level

$54K/yr - $146K/yr

3+ years exp

CVS Health is a leading health solutions company dedicated to transforming healthcare. They are seeking a Healthcare Analytics Business Consultant who will analyze healthcare data to support fraud detection and compliance reporting, utilizing strong SQL and Python skills.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

Write robust, efficient code in SQL and Python to extract, manipulate, and analyze large healthcare datasets

Design, develop, and maintain complex data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity

Prepare timely and accurate Medicaid regulatory & compliance reports in accordance with prescribed guidelines and standards

Communicate messages based on data analyses, including preparing easy-to-understand visualizations and other related documents for diverse audiences

Collaborate with SIU investigators, Program Integrity Manager, and Compliance to understand business processes and translate them into actionable data requirements

Develop and participate in presentation and consultation with business partners on data, capabilities and performance results

Identify data quality issues, perform root cause analysis, and recommend improvements to enhance reporting accuracy and data integrity

Stay informed about changes in Medicaid policy, regulatory requirements, and FWA detection techniques to ensure ongoing compliance

Qualification

SQLPythonData analysisExcelHealthcare knowledgeProblem-solvingCritical thinkingWritten communication

Required

A minimum of 3 years of data interpretation and analysis experience, preferable in the health insurance or Medicaid program

Ability to distill complex data into meaningful insights and present findings to non-technical audiences

2+ years experience interpreting medical claim data

Advanced experience in SQL & Python coding sourcing from a data warehouse

3+ years of project leadership experience

Strong business as well as systems knowledge

Excellent problem-solving, critical thinking, and written communication skills

Advanced experience in Excel

Preferred

Experience in healthcare fraud, waste and abuse

Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting

Experience with data visualization tools (e.g., Tableau, Power BI)

Familiarity with Big Query & Jupyter Notebook

Benefits

Affordable medical plan options

401(k) plan (including matching company contributions)

Employee stock purchase plan

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility