Manager – Health Services

Job not on LinkedIn

🔥 17 hours ago

⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

💵 $54.3k - $119.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Coordinate the identification of potential claim editing & clinical program enhancements to ensure compliance with Medicare NCDs and LCDs • Collaborate and partner with functional leads and other business areas to ensure quality and end-to-end payment accuracy functions • Provide support and management of savings opportunities and provider/customer deviation implementation

🎯 Requirements

• 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 • Current Registered Nurse (RN) preferred • Certified Professional Coder (CPC) preferred • Proficiency in ClaimsXten preferred

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs