Manager, W&E Professional Coding

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.

The Waste & Error Certified Coding Manager is responsible for leading the Certified Coding Analyst and W&E Team Lead roles that conduct medical claim reviews and coding audits to identify billing errors, waste, abuse, fraud, and payment integrity opportunities. The Manager provides direct people leadership, establishes operational priorities, ensures consistent application of coding and billing requirements, and is accountable for team productivity, quality, service levels, compliance, and employee development.

This role partners closely with the W&E team lead, who provides day‑to‑day technical guidance and subject matter support to the coding team. The Manager retains accountability for staffing, performance management, workload oversight, escalations, audit readiness, process improvement, and delivery of business outcomes. The position also represents the team in discussions with senior leadership, Medical Directors, Legal, Compliance, Analytics, Operations, and other Payment Integrity partners.

• Lead, coach, and develop a team of Certified Coding Analysts and Senior Certified Coding Analysts.
• Establish clear role expectations, performance goals, productivity standards, quality requirements, and accountability measures.
• Conduct regular performance discussions, provide timely feedback, recognize strong performance, and address performance or conduct concerns.
• Oversee hiring, onboarding, training, succession planning, engagement, and retention for the coding team.
• Deliver technical coaching, peer support, quality remediation, and ongoing education.
• Create an inclusive, collaborative team environment that promotes knowledge sharing, sound judgment, and continuous learning.

• Provide operational oversight for medical record reviews coding audits (Initial review, reconsiderations & appeals), and related waste and error activities performed by the coders.
• Assign priorities and manage work queues to ensure production, turnaround time, quality, and service level expectations are met.
• Monitor workload, staffing capacity, inventory, aging, and productivity trends; adjust assignments and resources as needed.
• Ensure analysts conduct comprehensive reviews and accurately apply CPT, HCPCS, ICD-10, modifier, CMS, state, federal, and organizational requirements.
• Oversee escalation pathways for complex coding questions, policy interpretation, Medical Director review, and case decisions.
• Ensure case findings and decision rationales are clear, complete, consistently documented, and supportable.
• Perform other duties as assigned.

• Establish and monitor quality review processes for coding audit work completed by the team.
• Review quality results, identify performance gaps, and implement targeted coaching, training, or corrective action plans.
• Ensure consistent application of coding guidelines, reimbursement requirements, business rules, workflows, and documentation standards.
• Maintain adherence to state, federal, contractual, accreditation, and organizational requirements.
• Partner with Legal, Compliance, Medical Directors, and other subject matter experts to resolve complex or high‑risk issues.
• Support internal audits, external audits,…