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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryWe are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a leading health insurance organization. This role is ideal for a data professional with strong skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste, and abuse (FWA) detection and Medicaid regulatory &amp; compliance reporting. This is an individual contributor role. Job responsibilities include:<ul> <li>Write robust, efficient code in SQL and Python to extract, manipulate, and analyze large healthcare datasets.</li> <li>Design, develop, and maintain complex data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity.</li> <li>Prepare timely and accurate Medicaid regulatory &amp; compliance reports in accordance with prescribed guidelines and standards.</li> <li>Communicate messages based on data analyses, including preparing easy-to-understand visualizations and other related documents for diverse audiences </li> <li>Collaborate with SIU investigators, Program Integrity Manager, and Compliance to understand business processes and translate them into actionable data requirements.</li> <li>Develop and participate in presentation and consultation with business partners on data, capabilities and performance results</li> <li>Identify data quality issues, perform root cause analysis, and recommend improvements to enhance reporting accuracy and data integrity.</li> <li>Document data logic and methodology used in analyses and ensure reproducibility and transparency of results.</li> <li>Stay informed about changes in Medicaid policy, regulatory requirements, and FWA detection techniques to ensure ongoing compliance.</li> </ul>This is a work-from-home position in the US. supporting standard east coast business hours. Required Qualifications<ul> <li>3+ years of experience in data analytics or data science, preferably in healthcare, health insurance, or Medicaid programs</li> <li>Ability to distill complex data into meaningful insights and present findings to non-technical audiences.</li> <li>Solid understanding and experience interpreting medical claim data</li> <li>Advanced experience in SQL coding sourcing from a data warehouse</li> <li>3+ years of data interpretation and analysis experience</li> <li>3+ years of project leadership experience</li> <li>Strong business as well as systems knowledge</li> <li>Excellent problem-solving, critical thinking, and written communication skills</li> <li>Advanced experience in Excel </li> </ul> Preferred Qualifications<ul> <li>Experience in healthcare fraud, waste and abuse </li> <li>Proficiency in Python coding</li> <li>Knowledge of Medicaid healthcare claims adjudication (QNXT) &amp; regulatory reporting</li> <li>Experience with data visualization tools (e.g., Tableau, Power BI</li> <li>Familiarity with Big Query &amp; Jupyter Notebook</li> </ul> Education<ul><li>Bachelor’s degree or equivalent experience</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,300.00 - $145,860.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Manager, SIU Data Analysis (SQL/Python)

Current Saint Francis Employees - Please click <a href="http://www.myworkday.com/saintfrancis/d/task/3005$4482.htmld" target="_blank">HERE</a> to login and apply. Full TimeDaysSchedule: Must be available to work full-time; Sunday - Thursday or Tuesday - Saturday.Job Summary: The Coder III Specialist codes ER, Outpatient, Outpatient Surgeries, Observations and Inpatient records. Minimum Education: High School Diploma or GED. Licensure, Registration and/or Certification: Certified Coding Specialist (CCS) by AHIMA. Work Experience: Minimum of 3 years related experience and a score of 80% or above on the outpatient and inpatient coding exam. Knowledge, Skills and Abilities: Demonstrated knowledge of Basic ICD 10 training and anatomy and physiology. Demonstrated PC and Software proficiency. Must be able to score 80% or above on the outpatient and inpatient coding exam. Essential Functions and Responsibilities: Codes ER's, outpatients, outpatients surgeries, observations and inpatients. Works CCI/medical necessity edits as needed. Monitors unbilled for all patient types coded on a day-to-day basis. Maintains quality equal to or greater than 95%. Maintains productivity equal to or greater than 95%. Completes continuing education as required. Decision Making: Independent judgment in planning sequence of operations and making minor decisions in a complex technical or professional field. Working Relationships: Works with internal customers via telephone or face to face interaction. Works with external customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Special Job Dimensions: None.Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.Health Information Clinical Coding - Yale CampusLocation:Virtual Office, Oklahoma 73105EOE Protected Veterans/Disability

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