Do you want to make an impact on a team? The Quality Advisor will partner with the benefits testing team to understand the area of improvements and standardization that is required. You will also collaborate with the team to make the project development phase successful. The Quality Advisor will facilitate Clinical testing, assess the efficiency improvements, and report the information to leadership. Our goal is to ensure processes meet internal and client audits.
The Quality Advisor will build strong internal and external partnerships and facilitate across different work groups. You will collaborate with Benefits and Implementation colleagues to ensure all parties understand and implement the tools that are needed for accurate benefit plan testing. And, you will actively participate on client calls and demonstrate the testing capabilities to gain more confidence from the client.
Additionally, you will develop process improvement initiatives to support department efficiencies and pinpoint areas of opportunity and training needs. The Quality Advisor will consult and mentor colleagues in performing benefit plan set ups and testing based on client requirements.
The successful candidate will have the following attributes:
• Outstanding organization, project management, and prioritization skills.
• Courteous and professional demeanor with the desire and skill to work as a team.
• Strategic, forward thinker with sound technical and analytical abilities.
• Ability to interact and influence senior leadership of the organization.
• Thorough and detailed knowledge of investigating, analyzing and effecting corrective action using experience to apply various methods and techniques that promote timely change and accountability.
• Strong team building, mentoring and coaching skills.
• Project Management expertise, well organized with the ability to effectively prioritize.
• Knowledge of QA principles, practices and procedures and ability to apply this knowledge to a variety of work assignments and compliance initiatives.
• Ability to research, analyze and interpret CMS rules and regulations, then apply them to current work assignments.
• 8+ years of experience in Quality or Benefit testing
• 2+ years of experience with SQL and Queries
• 2+ years of experience with PBM plans, Medicare, Medicaid, Commercial, HMO.
• Demonstrated success working with Client Operations in a PBM environment.
• Established knowledge of Federal and State agencies and their role in Healthcare legislation.
• Intermediate level of proficiency using Microsoft Office applications including Word, Excel, Power Point and Access.
• Shown capability using EzTest Tool to analyze data spreadsheets
• Demonstrated success performing Root Cause Analysis.
• Proven experience with Visio, Project and Facets
• Exhibited success utilizing verbal and written communication skills for collaboration with partners.
• Established knowledge of Health Plan benefits structures including an understanding of Healthcare documentation and resource requirements.
Bachelor's degree or equivalent work experience
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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