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Senior Business Analytics Analyst
Location
Maryland
Posted
54 days ago
Salary
$47.0K - $112.2K / year
Seniority
Senior
Job Description
Senior Business Analytics Analyst
CVS Health
• Manage daily Maryland Medicaid claims pend buckets to ensure timely and accurate claims adjudication and payment • Oversee inventory levels, turnaround times (TAT), backlog reduction, reduction of claims interest, suspended claims work queues, and provider dispute resolution • Drive improvements in auto-adjudication rates, accuracy, and first-pass resolution • Ensure all claims processes comply with State Medicaid regulations and billing guidelines, CMS requirements and Federal managed care rules, and timely filing laws • Support readiness reviews, audits, Corrective Action Plans (CAPs), and state submissions • Implement QA programs to monitor claim accuracy, provider payment integrity, and policy adherence • Review and analyze claims performance dashboards, error trends, and key metrics • Partner with Finance on claims reserves and cost-of-care reporting • Work closely with Configuration, Cotiviti, and Claim Xten to resolve system issues • Collaborate with Utilization Management/Medical Management on authorization-related claims issues • Coordinate with Compliance and Legal on regulatory changes and required process updates • Lead initiatives to streamline workflows, automate processes, reduce manual interventions, and improve accuracy • Drive root-cause analysis and implement sustainable corrective actions • Participate in the development of policy and procedure updates for Medicaid claims operations
Job Requirements
- Bachelor’s degree in Business, Healthcare Administration, or related field
- 3+ years of claims experience in Medicaid
- Strong understanding of Medicaid billing rules, HSCRC, provider types, benefit structures, and encounter reporting
- Experience with major claims systems (e.g., QNXT)
- Problem solving mindset; adaptable, ability to analyze processes
- Analytical skills with proficiency in Excel and claims data analysis
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- comprehensive benefits package designed to support physical, emotional, and financial well-being
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