Senior Manager – Business Compliance
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Job Description
Sr. Manager ensuring Medicare appeals compliance with CMS regulations at CVS Health. Managing CMS inquiries, audits, risks, and cross-functional regulatory readiness.
Responsibilities:
- Monitor and interpret new and evolving regulatory requirements and standards
- Serve as liaison with CMS representatives, external contractors, legal counsel, and internal teams
- Develop and maintain compliance oversight protocols
- Identify operational and compliance gaps and implement mitigation plans
- Collaborate with business leaders to maintain compliant policies and workflows
- Partner with Quality and Audit teams for CMS responses and internal, NCQA, departmental, and mock audits
- Use compliance reporting tools to track performance, identify trends, and escalate risks to executive leadership and business partners
- Create and manage a long-term operational strategy for appeals and audit responses
- Establish and lead cross-functional workgroups addressing compliance risks and regulatory requirements
- Monitor ongoing compliance, conduct risk assessments, and assist with audits
- Plan and execute projects related to compliance and regulatory requirements
Requirements:
- 7+ years Medicare experience related to the duties and responsibilities specified or an equivalent combination of education and work experience
- 7+ years of CMS audit, Medicare compliance or service operations experience
- Ability to understand complex problems and collaborate with business leaders to plan, solve, and execute solutions
- Experience working directly with CMS or other regulatory entities
- Associate’s degree or equivalent work experience
- Clinical licensure (RN) preferred
Benefits:
- CVS Health bonus, commission or short-term incentive program
- Award target in the company’s equity award program
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
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