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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.

Job Description: 

The Senior Manager Project Management Contract Platforms position performs and oversees multiple functions.

Primary responsibility is to oversee a team responsible for researching and analyzing Strategic pricing system functionality & enhancements. It also requires delineation of any other interfacing or manual manipulation altering the price. Validation of theory, when claim reports are furnished from other business areas.

They will also support the analysis of Aetna’s contract rate tools to identify operational improvement opportunities/validate a financial comment is needed, including walk through of the entry guidance when changes are warranted. The candidate must think critically, applying mastery pricing concepts to predict pricing outcomes.

This role will also provide project support which entails assessing risks both up & down stream, formulating business requirements, working in partnership with our IT counterparts, assembling testing strategies, validating testing results, including review and sign-off during code implementation. This role also includes formulation of training techniques, creation of the materials, and facilitation in partnership with other systems.

The candidate will also contribute to maintenance/ update all team training materials, including formulation of contract/claim examples, system mock-ups, and depiction of pricing outcomes. Candidate must be able to explain complex concepts in laymen’s terms, as well as furnish visual representations of the concepts.

Standard Service Grouping Maintenance- at least on a quarterly basis, coordinate with various service grouping content owners, analyze code sets, implement maintenance requests, then audit for accuracy. All Service Grouping code updates will ideally be completed prior the new service code’s effective date. Candidate will coordinate with business partners, including Provider Advance notification when off cycle code changes will be implemented.

Required Qualifications:

• 10+ years claim processing experience required
• Full understanding of the SCM rate wizard input, non-preferred contracting options, Carve out & grouper tabs.
• Familiar with Professional Component concept, and EPDB limitations related to same
• Moderate understanding of EPDB & SCSR: Provider & PBG selection logic; fee schedule & modifier pricing logic
• Demonstrated strong understanding of Strategic Pricer logic and concepts
• Excellent verbal and written communication skills

Preferred Qualifications:

• BIR/ Provider Solutions background
• Network Contracting and/or SCM Contracting support experience
• Familiarity with the various CMS payment methodologies supported by Strategic Pricer via Burgess software
• QuickBase user experience

Education :

Bachelor’s degree preferred/specialized training/relevant professional qualification.

Pay Range

The typical pay range for this role is:

$82,940.00 - $182,549.40

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.  This position also includes an award target in the company’s equity award program. 
 
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: 03/24/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.