Position SummaryThis role will be responsible for developing provider data, credentialing and additional reporting for internal, external, and departmental customers as required by the business and manage relationships and the reporting process from initiation through submission. This position will monitor compliance with requirements as needed by the business; gathering data from multiple sources to create reporting, identify trends, and ensure accuracy and completeness to inform strategic decision making. Manage the direct execution and documentation of the internal provider sanction process, monitor the sanction dashboard, and communicate with stakeholders on sanctioned and terminated providers. Function as a key operational control role, supporting audit readiness, regulatory compliance, and beneficiary protection. Manage projects to ensure on-time completion according to requirements and within expected timeframe of completion and additional assignments as needed by the business.
What you will do- Collect, analyze, and present data related to the provider data and credentialing processes.
- Interpret data, identify trends, and draw meaningful conclusions.
- Execute timely and accurately on the flagging of sanctioned providers to ensure they are removed from directories and claims payments are stopped and/or recovered.
- Maintain complete audit trails to support the work completed.
- Support updates to SOPs, job aids, and training materials.
- Manage multiple reporting projects with varying due dates and levels of priority.
- Identify recurring data issues or control gaps and recommend & execute on process improvements.
- Assess the impact of adopting new business analysis advances and make recommendations for their implementation.
- Assist with evaluating new technology, tools, and systems that can enhance business processes and operations.
- Collaborate with cross-functional teams, under minimal supervision, to gather and document business requirements, translate them into technical specifications, and provide recommendations for technology solutions.
- Develop skills outside of an existing comfort zone and encourage others to do the same.
- Effectively mentor others.
- Address conflicts or issues, engaging in difficult conversations with clients, team members and other stakeholders, escalating where appropriate.
Requirement Qualifications- 5+ years of data analysis and reporting experience
- Adept at problem solving and decision making
- Strong attention to detail and documentation accuracy
- Demonstrates experience handling sanctions/exclusions, regulatory or internal audits, and/or similar work with high compliance risk
- Experience in collaboration and cross functional teamwork
- Demonstrates strong verbal and written communication skills, with the ability to clearly articulate complex information to diverse audiences, including leadership and external stakeholders
- Track record of execution and delivery (planning, delivering, and supporting) skills
- Experience in provider data and provider credentialing
- Experience in data warehousing , SQL Queries and PowerBI
Preferred Qualifications- Certified Analytics Professional (CAP)
- QNXT, EPDB and/or PRMS system experience
Education- Bachelor's degree preferred/specialized training/relevant professional qualification.
Anticipated Weekly Hours40
Time TypeFull time
Pay RangeThe typical pay range for this role is:
$66,330.00 - $145,860.00
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.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 06/10/2026
