Project Management Manager

Job DescriptionThis position is a Subject Matter Expert for the HIPAA 837 Claim Intake and Encounter EDI transactions. This position will join a team of other EDI SMEs who are responsible for maintaining the day to day operations and integrity of the 837 Claim/Encounter transaction as well as support ongoing strategy and business development.Required QualificationsThe candidate must have:Familiarity with HIPAA, Electronic Data Interchange, 837 Claim/Encounter details.Familiarity with X12 Transaction Guidelines and industry standards.Familiarity with EWM, ACAS, HRP and HMO claim intake/ adjudication processes.Familiarity with ICD-10, HCPCS, CPT and other medical coding.Familiarity with Hospital, Professional and Dental claim submission formats.Works with business and IT constituents across key functional areas/lines of business to understand potential project impact on the transaction, organization, align project work, and execute activities accordingly.Presents to internal/external customers, constituents and business partners, strong business as well as systems knowledge and can perform reasonability checks.Participates with external industry workgroups as Aetna's representative for 837/Encounter EDI transactions.Perform issue analysis by utilizing system information, business knowledge and industry transactional fluences change or enhancements to business processes, policies and system infrastructure to improve information quality, availability and access.Develops and participates in presentation and consultation to existing and prospective customers, business partners and internal business areas on information services, capabilities and performance results.Proactively evaluates project activities, builds contingency plans, executes corrective action, and monitors issue resolution to mitigate risks such as scope and/or budget variances. 3-5 years related work experience. Familiarity with EDI. Familiarity with APLC - Agile and Waterfall. Proven track record meeting project dates. Excellent communication skills, both written and verbal. Ability to manage multiple priorities. Proven ability to affect change. Strong understanding of the healthcare industry and regulatory environment, including in-depth knowledge of medical and specialty products. Demonstrated ability to effectively coordinate multiple projects simultaneously. Experience communicating for impact. Experience maximizing work practices. Ability to turn data into information. Experience performing business information analysis. Experience providing E. Business support Ability to perform Issue identification and analysis Ability to assess risk Familiarity with Microsoft SharePoint Familiarity with Microsoft Word Familiarity with TE Microsoft ExcelCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Creating Accountability Developing and Executing Strategy Driving a Culture of ComplianceEducation Bachelor's degree or equivalent experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15