Manager – Health Services

CVS Health

Manager of Health Services coordinating claim editing and compliance with Medicare and Medicaid legislation. Collaborating with various teams to ensure payment accuracy and provider/customer implementation.

Posted 6/16/2026full-timeRemote • Virginia, West Virginia • 🇺🇸 United StatesMid-LevelSenior💰 $54,300 - $119,340 per yearWebsite

About the role

Key responsibilities & impact

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
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
provide support and management of savings opportunities and provider/customer deviation implementation

Requirements

What you’ll need

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
Compliance Program Guidelines including CMS Medicare NCD/LCD, Federal, and State Legislation experience
Medicare Rules and Regulations Healthcare Compliance experience
Proficiency in ClaimsXten
high school Diploma Required - Bachelors Preferred

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package designed to support physical, emotional, and financial well-being

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claim editingproject managementclaims processingresearching claimssavings opportunities management

Soft Skills

collaborationpartneringquality assurancecommunication

Certifications

Certified Professional Coder (CPC)