Reporting to CSRA director, Medicaid Benefit Analyst will perform analysis of source materials supplied by Health Plans, and document requirements for benefit administration in business application systems.
Position will be responsible for the research and review of State, CMS and internal documentation to determine correct benefits structure and system configuration. Candidate will review and update existing benefit grids and will be responsible for creating grids for new lines of business. Responsibilities also include issue resolution, ongoing system change request review, and periodic audit of the current benefit set up to ensure accuracy. Position will be a key resource and business partner to our Health Plans and CSRA Management for all benefit administration items.
Proven track record in meeting project milestones, strong management skills and the ability to work independently to achieve timely results
Collaborate with internal and external partners to produce accurate results
Independently research State, CMS and other internal and external source documentation to determine correct benefit structure and system set up requirements
Issue research and resolution
Time management to complete work according to documented service level agreements
Previous experience with claim processing and research resolution
Ability to interpret State and Health Plan source documentation and understanding of its relation to internal documentation and QNXT output
Knowledge of medical coding and terminology, certified coder not required
QNXT is Plus!
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
Knowledge of QNXT and Medicaid
No minimum requirement
At Aetna, a CVS Health company, 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 are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.