Corporate Compliance, Senior Manager

Job DescriptionThe Senior Manager position is an experienced career level compliance position with an expertise in Medicare Risk Adjustment to promote the integrity of the Medicare program. The manager applies compliance, regulatory, business, analytical and communications skills to support, manage and develop Medicare compliant process that promote compliance to prevent, detect and mitigate compliance risksThe Senior Manager ensures regulatory requirements of an effective compliance program are met, oversight and/or performance of auditing and monitoring, investigating potential ethics and compliance issues, validation of successful implementation of revised and new regulatory guidance, evaluating compliance risks, ongoing consultation and guidance with business on compliance matters.Responsibilities include but not limited to: Serve as a risk adjustment subject matter expert Interprets and provides feedback on CMS regulations and HCC risk adjustments reimbursement methodology Collaborates across the company and with vendors to help ensure the integration and alignment of risk adjustment daily operations and/or strategies Understanding of the Claim Overpayment Policies for Medicare Advantage Thorough understanding of Risk Adjustment, HCC coding, ICD coding, and RADV and IPM requirements. Act as liaison with external agencies and auditors Applies expert industry and compliance knowledge to lead and address compliance issues and related matters Oversees or conducts activities, including monitoring and auditing, as outlined in the Compliance Work Plan Proposes corrective action, where necessary, and monitors implementation of such corrective action Able to remove barriers, drive decision-making and influence ethical and compliance outcomesPay RangeThe typical pay range for this role is:Minimum: 75,400Maximum: 158,300Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsMinimum of 5+ years' experience in HCC-specific coding/auditing in Medicare Risk AdjustmentCCS-P (Certified Coding Specialist-Physician) or CPC (Certified Professional Coder)Preferred QualificationsCertified Professional Medical Auditor (CPMA )4+ years of experience in provider educationEducationBachelor's Degree or Minimum of 5 years' experience in HCC-specific coding/auditing.Business OverviewBring your heart to CVS Health Every 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-11-15