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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
The Medicaid Claim Editing Content Management team supports ad hoc project management and MPPS claim editing initiatives, including ClaimsXten and Cotiviti activities for QNXT. Plus claim analytics and coding reviews for the Medicaid health plans. In addition, the team oversees ongoing content delivery and maintenance across Medicaid claim editing vendors on QNXT, including supporting the Claim Editing Content Management and Claim Editing Provider Disclosure Tools; testing ClaimsXten deployments; managing system enhancements, customizations, and deviations to support ClaimsXten and Cotiviti; and maintenance of each health plan's service code, modifier, svccodemod exception list)
Required Qualifications
Familiarity with clinical and code editing concepts (Example: Claim Check, ClaimsXten)
• QNXT experience
• Extensive knowledge of CPT, HCPCS, ICD-10 coding
• Must be willing to work 1-2 Sundays each month for content updates
• Ability to prioritize and work in a fast paced, deadline oriented environment
• Excellent critical thinking skills
• Analytical and creative problem-solving abilities
• Experience with Outlook, Excel, and Word
• Excellent verbal and written communication skills
• Excellent listening and interpersonal skills
• Desire to work in a team-oriented, collaborative environment
Preferred Qualifications
Certified Professional Coding Certification (CPC)
Education
Bachelors Degree or Equivalent
Pay Range
The typical pay range for this role is:
$46,988.00 - $102,000.00
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
We anticipate the application window for this opening will close on: 03/03/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
