Manager - Health Services

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This role is responsible for operationalizing Aetna Clinical Policy Bulletins (CPBs) and Aetna Payment Policies into precise, testable coding logic that drives claims adjudication across lines of business. It serves as a critical control point to ensure accurate translation of clinical policy into claims editing configurations, aligned with regulatory, reimbursement, and organizational standards. The position ensures decisions are clinically appropriate, compliant, and consistently applied with full audit traceability, protecting policy integrity, claim accuracy, and enterprise compliance. Work hours: Monday through Friday, 8am-5pm ET or CT as meetings will occur during these work hours Required Qualifications 2+ years of experience in healthcare claims administration, coding, or configuration Medical Coding Certification (CPC, CIC, CCS, RHIT, or similar certification) **If not already a certified coder, candidate must obtain within first year of employment Extensive knowledge of CPT, HCPCS, ICD-10 coding Ability to prioritize and work in a fast paced, deadline-oriented environment Strong analytical, critical thinking, and problem-solving capabilities Experience with Microsoft Office applications (Excel, Word, Outlook) Excellent written and verbal communication skills with ability to clearly articulate complex concepts Desire to work in a team-oriented, collaborative environment Preferred Qualifications Experience with ClaimsXten, Lyric and/or Cotiviti Experience with policy governance, audit processes, or compliance environments Prior experience supporting medical policy or Payment Integrity initiatives Education Associate’s degree or equivalent experience Anticipated Weekly Hours 40 Time Type Full time The Typical Pay Range For This Role Is $60,300.00 - $145,860.00 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. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. 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. We anticipate the application window for this opening will close on: 08/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr CVS Health