Manager - Health Services (IC)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The ideal candidate will coordinate the identification of potential claim editing & clinical program enhancements to ensure compliance with Medicare NCDs and LCDs as well as Federal and State Legislation. This individual will also collaborate and partner with functional leads and other business areas to ensure quality and end-to-end payment accuracy functions in the Medicare NCD/LCD and Federal/State legislation policy space. They will provide support and management, as needed, of savings opportunities and provider/customer deviation implementation.

Skilled in:

• Effective Verbal and Written Communication
• Collaboration across various teams and levels

Ability to:

• Experience performing legal and/or regulatory research
• Manage multiple projects simultaneously, displaying strong organizational skills
• Demonstrated ability to review and understand various business operations in different settings
• Work independently, as well as in collaboration with, colleagues from across organization to monitor compliance strategies
• Escalate risks and identified issues timely to leadership and work towards meaningful solutions

Required Qualifications

• Certified Professional Coder (CPC)
• 3+ years processing and/or researching claims for appropriate claim editing
• 3+ years experience in successfully meeting project deliverables 
• 5+ years in Managed Care/Healthcare experience
   

Preferred Qualifications

• Current Registered Nurse (RN)
• Compliance Program Guidelines including CMS Medicare NCD/LCD, Federal, and State Legislation experience
• Medicare Rules and Regulations
• Healthcare Compliance experience
• Proficiency in ClaimsXten

Education

High school Diploma Required  - Bachelors Preferred

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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