Project Program Management Medical & Payment Policy Senior Manager

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. candidate may reside anywhere in the US Position Overview The Senior Manager, Medical and Payment Policy Performance Research and Correct Coding Analysis independently develops and manages assigned policy and coding reviews by evaluating clinical and payment policies and identifying potential issues. This position ensures coding aligns with defined medical and pre-payment policies, identifies opportunities to optimize performance, and supports organizational goals and regulatory requirements. The role partners closely with claims operations to apply policy intent across end-to-end claims processing (intake, edits, adjudication, denials, appeals, and adjustments) and to drive consistent, compliant outcomes. Key Responsibilities Collaborate with cross-functional teams—such as IT, compliance, operations, and provider relations—to ensure seamless integration of claims coding changes and resolve complex configuration issues. Monitor and report on claims coding and configuration accuracy, trends, and key performance indicators (KPIs), providing actionable insights for process improvement. Leverage claims processing experience to evaluate end-to-end workflows (front-end edits, adjudication logic, denials, appeals, and adjustments) and translate findings into actionable policy/coding guidance and claims platform configuration or testing support. Stay up to date with industry developments, payer and provider requirements, and regulatory changes affecting claims coding and configuration. Develop and maintain documentation for identifying cla...