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Fast-paced healthcare provider support role intended to foster a positive provider experience by supporting the end-to-end process of defining and supporting SOC and SOX controls through collaborating with cross-functional teams. This position will support network across all lines of business at CVS Health.
Job Responsibility:
Understanding business operations to identify gaps and areas where new controls are required
Facilitation of business process and control documentation, including developing new controls and ensuring controls are designed appropriately to effectively manage risk
Identify and proactively notify all impacted areas of control changes that may require enhancements, process changes, or other updates
Partner with stakeholders to continuously evaluate and recommend opportunities to reduce risk, strengthen the internal control environment, and introduce operational efficiencies
Independently collect facts, utilize strong analytical capabilities to recommend appropriate actions on complex matters, and effectively communicate status and results
Accountable for all steps within the life cycle of control testing including conducting walkthroughs with Internal and External auditors, maintaining Information Provided by Entity (IPE) and providing documentation as needed when audit selections are made
Responsible for monthly and bi-annual controls review, including audits of Provider Tab and Rate Wizard transactions, Fee Schedule, and Rate Load Tracking Database audits
Support audits out of QNXT and PRMS systems to support Medicaid SOC and SOX controls
Coordinate with applicable reporting areas as needed to ensure reports are generated timely and are continuously reviewed for process efficiencies
Must be able to effectively prioritize and review the status of assigned work to track progress and manage towards business objectives and compliance due dates
May be asked to support other projects as needed based on business need
Requirements:
5+ years compliance and/or audit experience in SOC and SOX controls
5+ years of project management experience
Health insurance industry experience
Strong communication, critical thinking, problem resolution and interpersonal skills with proven ability to influence and collaborate with providers and internal partners at all levels
Excellent analytical and problem-solving abilities
Ability to work independently and manage multiple priorities
Detail-oriented with a high level of integrity and professionalism
Bachelor's degree preferred / specialized training / relevant professional qualifications
Nice to have:
Advance working knowledge of business systems, applications, and tools supporting network management, contracting, and provider data systems
Experience in related business environment with exposure to provider data, processes, etc.
What we offer:
Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access
CVS Health bonus, commission or short-term incentive program
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