Manager - Health Services

Aetna Clinical Policy Bulletins And Payment Policies Specialist

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.

This role is responsible for operationalizing Aetna Clinical Policy Bulletins (CPBs) and Aetna Payment Policies into precise, testable coding logic that drives claims adjudication across lines of business. It serves as a critical control point to ensure accurate translation of clinical policy into claims editing configurations, aligned with regulatory, reimbursement, and organizational standards. The position ensures decisions are clinically appropriate, compliant, and consistently applied with full audit traceability, protecting policy integrity, claim accuracy, and enterprise compliance.

Work hours:

Monday through Friday, 8am-5pm ET or CT as meetings will occur during these work hours

• 2+ years of experience in healthcare claims administration, coding, or configuration
• Medical Coding Certification (CPC, CIC, CCS, RHIT, or similar certification)
  ** If not already a certified coder, candidate must obtain within first year of employment
• Extensive knowledge of CPT, HCPCS, ICD-10 coding
• Ability to prioritize and work in a fast paced, deadline-oriented environment
• Strong analytical, critical thinking, and problem-solving capabilities
• Experience with Microsoft Office applications (Excel, Word, Outlook)
• Excellent written and verbal communication skills with ability to clearly articulate complex concepts
• Desire to work in a team-oriented, collaborative environment

• Experience with Claims Xten, Lyric and/or Cotiviti
• Experience with policy governance, audit processes, or compliance environments
• Prior experience supporting medical policy or Payment Integrity initiatives

Associate's degree or equivalent experience

Anticipated Weekly

Hours:

40

Time Type:
Full time

Pay Range: $60,300.00 - $

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.