Senior Manager - Clinical Claims Editing and Configuration Management

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
environmentPreferred Qualifications
CPC helpful, but not required

Education
Bachelor's Degree or equivalentPay 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 peopleWe 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/benefitsWe anticipate the application window for this opening will close on: 04/06/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.