Payment Policy Writer - Code Editing Manager Health Services

CVS Health

2d • Remote

About The Position

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. May reside anywhere in the US Position Summary The Health Service Manager -Policy Writer for Medicaid is a key member of the Medical Policy & Program Solutions Team. The Medicaid Medical Coding Policy Writer is an individual contributor and will research and develop moderate to complex coding and payment policies; ensure adherence to company, state, and federal guidelines. In addition, this role will support the written communications shared with our state Medicaid Health Plans to complete the required State and Provider Notification communications. These activities enable Aetna Medicaid to improve health care quality services, and processes by partnering across business units to meet business needs and accomplish goals. This is a fully remote position. Eligible candidates may live anywhere in the contiguous United States.

Requirements

• 3 years of healthcare-related writing experience.
• Experience in writing payment policies for state specific Medicaid policy, Medicare policy writing a plus.
• 3 years of experience in medical policy development and/or implementation.
• Coding and managed care background.
• Effective communication skills, both verbal and written.
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.
• Proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Strong presentation skills.
• Ability to travel up to 10% for meetings as needed.

Nice To Haves

• Certified Professional Coder through AAPC or AHIMA (Physician, Inpatient, Outpatient or Payer), or Registered Health Information Technician (RHIT)

Responsibilities

• Ensures compliance with healthcare regulations and policies for state Medicaid and Duals line of business as it related to payment policies.
• Support the operational processes of the Medicaid Health Policy Governance
• Monitor status reports to ensure effective workflow and timely development of coding and payment policies
• Support internal departments and processes in the development and implementation of policies and procedures
• Ensure all medical policies are compliant with relevant regulations and are consistent across all lines of business
• Participate in department initiatives, scorable action items, and projects
• Work with health plan business leaders and corporate leaders to develop deliverables on policy priorities
• Provide medical coding and payment policies deliverables for Medicaid and Duals and other markets as business needs change
• Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies
• Collaborate with interdisciplinary team members to achieve team goals
• Perform any other job duties as requested

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager