Manager - Health Services

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.

Required Qualifications

• Strong knowledge of Compliance Program Guidelines including CMS Medicare NCD/LCD, Federal, and State Legislation
• Experience processing and/or researching claims for appropriate claim editing
• Experience in successfully meeting project deliverables
• Experience in Managed Care/Healthcare

Preferred Qualifications

• Current Registered Nurse (RN)
• Certified Professional Coder (CPC)
• Experience in Medicare Rules and Regulations
• Healthcare Compliance experience
• Proficiency in ClaimsXten

Skills

Effective Verbal and Written Communication
Collaboration across various teams and levels
Ability to manage multiple projects simultaneously, displaying strong organizational skills
Experience reviewing and understanding various business operations in different settings
Experience working independently, as well as in collaboration with colleagues from across the organization to monitor compliance strategies
Experience escalating risks and identified issues to leadership and working towards meaningful solutions

Benefits

The typical pay range for this role is $54,300.00 - $119,340.00. 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.

We 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.