Compliance Analyst - Monroeville, PA (Hybrid)

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 Summary

CVS Health Specialty Pharmacy, a mail service pharmacy in the Monroeville area has an opportunity for a full-time Compliance Analyst, Revenue Cycle. The Compliance Analyst, Revenue Cycle is responsible for the review, update and maintenance of the Medicaid regulation system files used to support Specialty A/R billing activities. Additionally, the Compliance Analyst, Revenue Cycle may assist the audit team by collecting necessary documentation for audit requests as needed. (i.e. internal, external, Onsite audits, Medicaid, PDE, etc.). As part of this team, you will work in a fast paced and team focused environment.

We will support you by offering all the tools and resources you need to be successful in a collaborative team environment.

Located in the Monroeville facility, this opportunity also provides free parking.

Role Overview:

• Hybrid Role

Key Responsibilities of the Compliance Analyst, Revenue Cycle:

• Responsible for understanding and effectively updating each data field of the Medicaid regulations system files
• Maintain and update Medicaid regulation system files in compliance with the update schedule
• Research Medicaid regulatory codes and other state-published guidance
• Receive Medicaid payer notices, remain informed of payer regulation changes and retain notices for future reference.
• Ensure that necessary departments are notified of changes to the Medicaid regulation system files
• Assist the audit team in collecting necessary documentation as needed to support timely audit request responses
• Assist with educating staff on departmental policies and procedures
• Assist with any enterprise or department special projects, as needed

Required Qualifications

• 1-3 years of health care billing and/or revenue cycle experience.
• 1+ years of MS Office experience.
• Demonstrated ability to handle multiple tasks simultaneously and to prioritize accordingly.
• Proven ability to work with a high degree of accuracy and attention to detail
• Excellent verbal and written communication skills.
• Able to work effectively with other internal/external functional departments
• Must be able to commute to the Monroeville, PA office

Preferred Qualifications

• 1+ years of Medicaid or Medicare regulations experience.
• 1+ years of regulatory compliance experience.
• 1+ years of managing contracts or reviewing contracts.
• Previous SharePoint and Excel experience.
• Bachelor’s degree (B.A.) from four-year college or university; or 3-5 years related industry experience and/or training; or equivalent combination of education and experience.

Education

• Verifiable High School Diploma or GED required.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $85,068.00

This 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 people

We 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:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 04/29/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.