At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Business critical position to manage the Commercial and Medicare claim editing content configuration management and analytics team. The Senior Manager will oversee ongoing content delivery and maintenance across all claim editing vendors, including supporting the

Claim Editing Content Management Tools (Content Manager for ClaimsXten, Cotiviti Connect / JIRA for PPM/CV); leading the ClaimsXten Delta and Dictionary creation and deployment processes; testing ClaimsXten, CCES, PCCV, CV, and PPM deployments; managing system enhancements, customizations, and deviations to support ClaimsXten, CV, and PPM. Responsible for End-to-End Systems Testing (Pre-Implementation Testing and Post Go-Live Validation via ClaimLab for ClaimsXten/CCES bi-weekly updates, QA testing to validate PPM/CV/PCCV edits are set-up correctly prior to being sent to Cotiviti, and project implementation and new rule testing (ClaimsXten Dictionary, ClaimLab, Development, System, SQA, and UAT testing) CCES/Novologix/CV/PPM Claim Editing QA Process (Post-Implementation Validation via Daily Edit Recommendation Reviews) CV & PPM ACAS Claim Analytics (Quarterly Adjustment, Monthly Unreconciled, Monthly Discrepancy, Monthly Unlock, and Monthly Override Reviews).

Required Qualifications

*Demonstrated Leadership Skills 
*Experience managing a complex team with diverse skillsets 
*ACAS and HRP Experience  
*Familiarity with clinical and code editing concepts and 
products (Example: CXT, CCES, PPM & CV) 
• Extensive knowledge of CPT, HCPCS, ICD-10 coding 
• Must be willing to work 1-2 Sundays each month for 
content updates 
• Ability to prioritize and work in a fast paced, deadline 
oriented environment 
• Excellent critical thinking skills 
• Analytical and creative problem-solving abilities 
• Experience with Outlook, Excel, and Word 
• Excellent verbal and written communication skills 
• Excellent listening and interpersonal skills 
• Desire to work in a team-oriented, collaborative 
environment

Preferred Qualifications
CPC helpful, but not required

Education
Bachelor's Degree or equivalent

Pay Range

The typical pay range for this role is:

$82,940.00 - $182,549.00

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.  This position also includes an award target in the company’s equity award program. 
 

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 04/06/2025

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