Senior Compliance Lead, Medicare Regulatory Audits

CVS Health; Charleston (WV); On-site; USD 68,000 - 199,000; Full time

Benefits offered by this job

Health benefits

Bonus program

Equity awards

Paid time off

Job summary

CVS Health is seeking a Senior Manager, Business Compliance to lead Medicare appeals compliance for Part C and Fast Track Appeals. You will align processes to CMS rules, coordinate with Legal and Compliance teams, and drive audit readiness across the organization.

The role demands strong regulatory knowledge, cross-functional collaboration, and the ability to manage complex regulatory risks while guiding improvements. This is a full-time on-site opportunity in the Charleston area.

Qualifications

• 7+ years Medicare experience related to the duties and responsibilities specified or an equivalent combination of education and work experience.
• 7+ years of CMS audit, Medicare compliance or service operations experience.
• Ability to understand complex problems and collaborate with business leaders to plan, solve, and execute solutions.
• Experience working directly with CMS or other regulatory entities.

Responsibilities

• Monitor and interpret new and evolving regulatory requirements and standards, ensuring the organization's processes and practices remain compliant.
• Function as a liaison with CMS representatives, external contractors, legal counsel, and internal teams to ensure alignment on regulatory and operational issues.
• Develop and maintain compliance oversight protocols, ensuring adherence to expedited timelines and regulatory expectations.
• Identify operational and compliance gaps and develop and implement mitigation plans.
• Collaborate with business leaders to ensure departmental policies and workflows are compliant and reflect current regulatory requirements.
• Partner with Quality and Audit teams to prepare for and respond to CMS and internal audits.
• Compliance reporting tools to track performance, identify trends, and elevate risks to ELT and key business partners.
• Create and manage a long-term operational strategy to manage appeals and audit responses.
• Establish and lead cross-functional workgroups to address compliance risks, implement new regulatory requirements, drive continuous improvement.
• Monitor ongoing compliance across business units, conduct risk assessments, and assist with audits.
• Drive the planning and execution of projects related to compliance and regulatory requirements.

Skills

Medicare experience

CMS audit experience

Regulatory compliance

Cross-functional collaboration

Risk management

Regulatory interpretation

Education

Associate's degree or equivalent

Job description

CVS Health is seeking a Senior Manager, Business Compliance to lead Medicare appeals compliance for Part C and Fast Track Appeals. You will align processes to CMS rules, coordinate with Legal and Compliance teams, and drive audit readiness across the organization.

The role demands strong regulatory knowledge, cross-functional collaboration, and the ability to manage complex regulatory risks while guiding improvements. This is a full-time on-site opportunity in the Charleston area.