Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

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.

Skill 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

• Must be familiar with claim editing software to propose system changes and ensure claim editing accuracy
• Proven track record in meeting project milestones and negotiating for resources

Preferred Qualifications

• Certified Professional Coder (CPC)
• 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 degree and equivalent work experience

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 10/26/2024

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