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　　Position Summary

　　The Eligibility Analyst plays a key role in managing and reconciling OhioRISE eligibility and CME enrollment issues. The Eligibility and Stratification Analyst will provide support on a wide range of complex enrollment activities.

　　The position reports to the Chief Operating Officer and works in close partnership with the Director of the CME Alliance Hub and all matrixed growth partners to effectively support our CME partners and the youth and families in their care. Successful candidate must live in Ohio or be willing to relocate.

　　Business Overview

　　As part of the bold vision to deliver the "Next Generation" of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.

　　Summary/Position Objectives:

　　The Eligibility and Stratification Analyst plays a key role in managing and reconciling OhioRISE eligibility and CME enrollment issues. The Eligibility and Stratification Analyst will provide support on a wide range of complex enrollment activities. The position is responsible for ensuring prompt and accurate enrollment information achieved through daily enrollment report reviews.

　　The position reports to the Chief Operating Officer and works in close partnership with the Director of the CME Alliance Hub and all matrixed growth partners to effectively support our CME partners and the youth and families in their care. Successful candidate must live in Ohio or be willing to relocate.

　　Responsibilities include:Reconcile ODM eligibility files with CME membership files to ensure the accuracy of CME assignmentsDaily review of enrollment reports to research and resolve errors in eligibility coverage breaks, correct duplicate member ID numbers and monitor retro Medicaid reinstatements for downstream impact on claims.Health plan representative for enrollment revenue reconciliation meetingsResponsible for Enrollment reporting and for ad hoc requestsUse databases and Excel to identify and analyze trends in dataIdentify manual processes for automation opportunitiesReview error reports and process file fall outsResponsible for the update of workflows and policy and proceduresProvide thorough, timely, and accurate resolution of reconciliation disputes and escalated complex cases via telephone, email, and other methodsAccurately research and resolve data discrepancies to ensure data integrity across external partners.Analyze data, identify trends, technical issues, and comparison issuesRequired Qualifications3-5 years of experience with Medicaid and enrollment processesDemonstrated relationship management skills; capacity to quickly build and maintain credible relationships at varying levels externally and within the organizationStrong organization skills, creativity and member focused approachDemonstrated proficiency with personal computer, keyboard navigation skills and with MS Office Suite applications (Outlook, Word, Excel, PowerPoint, SharePoint, etc.)Preferred Qualifications

　　Familiarity with Ohio Medicaid eligibility process

　　Education

　　Bachelor's degree in a closely related field or an equivalent combination of formal education and recent, related experience.

　　Pay Range

　　The typical pay range for this role is:

　　$19.52 - $40.10

　　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.

　　In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

　　For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

　　CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

　　You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

　　CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.