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CVS Health · 1 day ago

Compliance Manager

Hartford, CT

Full-time

Onsite

Senior Level

$66K/yr - $146K/yr

5+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care for millions of Americans. The Compliance Manager will oversee All Payer Claims Database (APCD) states, ensuring the organization adheres to regulatory requirements while managing high-risk areas, mentoring team members, and creating reports for management.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

Running/reviewing/setting up simple to complex projects end to end, Including setting up timelines, requesting extensions, communicating with regulators. Translating regulations into business requirements, both complex and simple, across all facets of the company. Using automated tools and reports as well as non-automated tools

Research and investigates issues identified both internally and by our customers. Identifying possible system issues and assists with correction of the issues identified. Writing complex business requirements based on findings to ensure a successful correction of issues identified

Utilizing knowledge of data sources, systems, products to influence changes in processes in place to streamline and automate as much as possible

Mentors/Trains/Coaches within 1:1 environment or broadly in group settings with all levels either voluntarily or when sought by others. Provides technical support for tools used in the department. Creation of training material for department

Builds strong teams within the APCD team, across other teams to optimize results and staff utilization

Effectively communicates verbally and in writing using language suitable to audience. Effectively communicate negative news to regulators whether in writing, verbally or in person. Effectively communicate with PBM account managers and clients, setting expectations and timelines. Escalate issues to business partners and senior team members

Create and maintain process documents, ensure proper record of submission, documentation of actions taken, documentation of files reported, status of files and other work-related tasks. Maintains appropriate documentation on reporting requirements for assigned states, writes/updates Policies and Procedures for the team

Qualification

Compliance experienceHealthcare product knowledgeData interpretationProject managementSASSQLExcelDatabase toolsVerbal skillsOrganizational skillsWritten skills

Required

Minimum 5 years of experience in Compliance/Legal in healthcare, insurance or financial services setting

Minimum 5 years of knowledge of all types of health care products including HMO, PPO, Medicare Advantage and Medicare Part D

Minimum 2 years of knowledge of all types of pharmacy products including specialty drug, Medicare Part D and understanding of PBM operations

Ability to travel up to 10% (including plane)

Preferred

4-6 years of data interpretation and analysis experience

5-8 years of experience in technology – SAS, SQL, ACL, Excel, Other database tools, Microsoft Office Suite

Extensive experience with databases as well interpretation and manipulation of related data

8+ years of healthcare background – ability to review and interpret State/Federal regulations/legislation and create business requirements

3-5 years of experience in project management and process redesign

3+ years Compliance related functions including contact with regulatory bodies

Strong organizational skills - ability to manage multiple projects, tasks and deliverables simultaneously, reprioritizing as needed

Strong written and verbal skills - ability to request and interpret complex information and to communicate within CVS Health and with external business partners

Ability To: Influence change or enhancements to business processes, policies, and system infrastructure to improve information quality, availability, and access. Driving enhancements and data quality processes to ensure compliance with state/Vendor guidelines

Analyze data quality for trends, highlights in-depth interpretations, and provides in-depth root cause analysis

Understanding of how healthcare claims are billed and understanding of how industry codes work together

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.