Manger, Business Consulting

Job DescriptionAs a Business Consulting Manager within the Revenue Integrity COE organization, you will be leading Risk Adjustment technical activities, not limited to electronic medical record data extraction, reconciliation and aggregation, and financial and operational reporting. Responsible for providing guidance and direction to external vendors, external consultants, team members and/or matrixed staff as required to support Risk Adjustment Revenue Integrity initiatives. Responsible for leading the reconciliation of data related to Epic Payer Platform to Revenue Integrity systems, identifying gaps with in the process, and leading to develop more efficiency within the process. Act as business lead for system design and in testing new functions, as well as, the support of auditing activities related to comparing encounter data from upstream systems to baseline expectations from Revenue Integrity systems as well as other technical projects. Drive change related to enhancements and system fixes. Understanding interdependencies both process wise and timing wise, to further business objectives. Communicate technical, resource and capacity needs to ensure timely deliverables. To be successful, the candidate will use their knowledge and experience to create meaning from the data. This position also supports coordination across all shared services and vendors to assure data integrity and data validation processes are in place. You will be responsible for auditing tasks including documenting and evaluating critical controls. You will be responsible for understanding procedures, results and business impacts; and document and express such understanding in both written and verbal form. Conducts periodic updates of analytical routines and department production systems. Investigates and evaluates alternative solutions to meeting business needs.Pay RangeThe typical pay range for this role is:Minimum: 60,300Maximum: 130,000Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsMust have experience with IT application development lifecycles, methodologies.Experience influencing others by turning data into meaningful and actionable informationExperience with SAS/SAS EG/Python/SQL server in data analytics and manipulationAttention to detailVendor management experienceStrong negotiation skillsExperience documenting business processes, as well as, recommending and implementing improvement strategies. Ability to perform testing functions.Participates in system design.Ability to audit the accuracy of reporting against source documents/reports/databases.Ability to implement auditing procedures5 or more years of healthcare, health insurance, or relevant combination of experienceStrong problem-solving, analytical, critical thinking and project management skills.10+ years experience with several of the following methodologies: management consulting, project consulting, business process consulting, financial strategic analysis strategic business planning, and/or risk management consulting.Experience with CMS Risk Adjustment programsPreferred QualificationsSee required qualificationsEducationBachelor's degree in Mathematics, Economics, Statistics, Computer Science, Actuarial Science, Social Science, Healthcare or related discipline. or equivalent experience.Business OverviewBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected 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.

Created: 2025-11-15