Configuration Management Manager

s, customizations, and deviations to support ClaimsXten and Cotiviti; and maintenance of each health plan's service code, modifier, svccodemod exception list).

Ad hoc project management and support for MPPS claim editing initiatives, including claim analytics and coding reviews for Medicaid health plans, handling coding questions for claims, contracts, benefits, and references files (CPT, ICD 10, Modifiers, ICD 10

Procedure Codes, Revenue Codes, and DRGs) and identify and facilitate resolutions to configuration, processing, and billing issues. In addition, must oversee

Medicaid Pre Implementation Testing (QA testing to validate PPM edits are set up correctly prior to being sent to Cotiviti, project implementation and new rule testing (Development, System, SQA, and UAT testing, and testing for implementation of ClaimsXten for all Medicaid health plans). Also responsible for Medicaid PPM QNXT Claim Editing QA Process (Post Implementation Validation via Daily Edit Recommendation Reviews), PPM QNXT Claim Analytics (Monthly Unreconciled, Monthly Discrepancy, and ad hoc claimRequired Qualifications
Demonstrated Leadership Skills
*Experience with system testing and post go-live validation
Familiarity with clinical and code editing concepts and
products (Example: Claim Check, ClaimsXten, Cotiviti PPM & CV)
• 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

Preferred Qualifications

Clinical Coding Experience - Content Manager

Claim Processing Medicaid

Working with SQL Application

Experience managing a complex team with diverse skillsets

QNXT Experience
Understanding of claim processing guidelines
Understanding of referral & service authorization
requirements and logic
Knowledge of legal, regulatory, and policy
compliance issues related to medical coding and
billing procedures and documentation
Data query and analysis skills

Education Diploma or Associates, Bachelor's preferredAnticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$54,300.00 - $145,860.00This 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.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.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 06/27/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.