[Hiring] Manager - Health Services @CVS Health

Role Description

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:

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

Qualifications

• Strong knowledge of Compliance Program Guidelines including CMS Medicare NCD/LCD, Federal, and State Legislation experience
• 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

Requirements

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

Education

• High school Diploma Required
• Bachelors Preferred

Benefits

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
• Other resources, based on eligibility

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

Pay Range

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.