CVS Health Medicare Part B Operations Analyst in Woonsocket, Rhode Island

Job Description

The Medicare Part B Operations Analyst is an ambassador and subject matter expert for Medicare Part B end-to-end adjudication activities. The analyst will assist in ensuring CVS compliance to Medicare Part B requirements and successful claims processing.

The primary responsibility of this position will encompass reporting and analytics utilizing internal and external data sources to support pre and post-adjudication operations with pharmacy colleagues and other support personnel, process improvement formulation, generating operating efficiencies recommendations and assisting with developing/implementing best in class operational solutions.

Responsibilities Include:

• Root cause analytics to understand process opportunities,

• Working with key stakeholders to develop training materials and standardize processes to drive efficiencies in a variety of pharmacy processes, and

• Development of action plans to ensure continuous operational improvement with external vendor

Required Qualifications

• 2+ years of related work experience, preferably in healthcare or retail pharmacy experience.

• 1+ years with MS Office applications including Excel, Access, and Word

Preferred Qualifications

• Medicare Part B or CMS policy and guidelines experience

• Understanding of CVS pharmacy operations and CVS store experience

• Familiarity with data mining tools

• Proven ability to deliver accurate results

• Strong problem solving and analytical skills including identifying trends, gaps, and opportunities

• Ability to handle complex, detailed data-orientated tasks with a high degree of accuracy

• Excellent interpersonal skills including the ability to impact and influence other at multiple levels internal and external to our organization by leveraging analytical tools and root cause analysis

• Good written and verbal communication skills including professional presentation

• Ability to develop communications including store training materials, policies and procedures

• Strong organizational and follow up skills

• Ability to multi-task and manage multiple projects while achieving on-time results

• Ability to work in strict confidence, ensuring the confidentiality of patient medical records in compliance of CVS and HIPAA privacy guidelines


High School Diploma or GED required.

Business Overview

CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW at and EEO IS THE LAW SUPPLEMENT at

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking Advice and Counsel at mailto:Advice&

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: