Manager - Health Services

CVS Health; Columbus (OH); On-site; USD 60,000 - 146,000; Full time

Job summary

CVS Health is seeking a detail-oriented policy implementation specialist to operationalize Aetna Clinical Policy Bulletins and Payment Policies into testable coding logic for claims adjudication. The role ensures clinically sound, compliant edits with full audit traceability across lines of business.

Work hours align with standard business times, and the position includes full-time hours with comprehensive benefits.

Qualifications

• 2+ years of experience in healthcare claims administration, coding, or configuration.
• CPC, CIC, CCS, RHIT, or similar certification (must obtain within first year).
• Extensive knowledge of CPT, HCPCS, ICD-10 coding.
• Ability to prioritize in a fast-paced, deadline-driven environment.
• Strong analytical, critical thinking and problem-solving skills.

Responsibilities

• Operationalize Aetna CPBs and Payment Policies into precise, testable coding logic.
• Ensure audit traceability and regulatory/compliance alignment.
• Support claims adjudication across lines of business.

Skills

Healthcare claims

Analytical thinking

Written and verbal communication

Team orientation

Prioritization under deadlines

Education

Associate’s degree

Tools

Excel

Word

Outlook

CPT coding

HCPCS coding

ICD-10 coding

Job description

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.