Senior Manager, Medicare Compliance & Audit Readiness

CVS Health; Tallahassee (FL); On-site; USD 68,000 - 199,000; Full time

Job summary

CVS Health is seeking a Sr, Manager, Business Compliance for the Medicare appeals program. The role ensures alignment with CMS regulations, manages CMS inquiries, and leads readiness for audits across Part C and Fast Track Appeals.

You will partner with Medicare Compliance, Legal, Operations Integrity, and Quality & Audit to ensure compliant, auditable appeals processes. The position requires strong Medicare knowledge, excellent communication, and cross-functional collaboration to manage risks

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 to ensure compliance.
• Function as a liaison with CMS representatives, external contractors, legal counsel, and internal teams.
• Develop and maintain compliance oversight protocols with expedited timelines.
• Identify operational and compliance gaps and develop mitigation plans.
• Collaborate with business leaders to ensure policies reflect current regulatory requirements.
• Prepare for and respond to CMS and internal audits; participate in mock audits.

Skills

Medicare experience

CMS audits

Regulatory collaboration

Problem solving

Education

Associate's degree

Job description

CVS Health is seeking a Sr, Manager, Business Compliance for the Medicare appeals program. The role ensures alignment with CMS regulations, manages CMS inquiries, and leads readiness for audits across Part C and Fast Track Appeals.

You will partner with Medicare Compliance, Legal, Operations Integrity, and Quality & Audit to ensure compliant, auditable appeals processes. The position requires strong Medicare knowledge, excellent communication, and cross-functional collaboration to manage risks