Senior Consultant

Job DescriptionReporting to the Lead Director of ACA Revenue Integrity, the Sr.Consultant, will work closely with various RI Lead Directors and subject matter experts across the ACA Individual (IFP) business to establish and champion market level revenue integrity excellence. This position is responsible for supporting all assigned market level risk adjustment activities and processes related to complete and accurate diagnosis capture through provider and member engagement. In support of the RI Lead Directors and the Executive Director this position will: Create and maintain assigned market and provider specific reporting and presentation materials. Conduct follow-up action items on market and provider specific action items. Facilitate and coordinate with team analyst on month over month member specific reporting metrics. Assemble data to produce ACA dashboard reporting specific to ACA-IFP Revenue Integrity efforts for various governance, market, and executive leadership meetings. Generate related presentation materials from dashboards with analysis of current state and opportunities Work closely with the Informatics team, team project manager, and team analyst to identify and implement data and ACA RAD enhancements as well as resolve issues. Facilitate RI Chart Retrospective and RADV chart retrieval annual escalation process Generate/maintain other reporting as required Support other RI ACA initiatives as requiredPay 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 Qualifications Bachelor's degree 5-7 years of experience in healthcare Proven ability to manage multiple projects simultaneously and meet deadlines Strong analytical and problem-solving skills Excellent communication, presentation, and writing skills Highly organized with excellent attention to detailPreferred Qualifications Experience with Medicare or ACA risk adjustment Familiarity with project management software, such as Microsoft ProjectEducationBachelor's degree 5-7 years of experience in healthcareBusiness 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