Manager, Medical Economics

CVS Health • Illinois, Illinois • 8h ago

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.

Position Summary

The Medical Economics Manager Auditor positions supports the Charger Master team and Provider Network functions by performing audits related to provider contracts, Facility Charge Master reporting, financial arrangements, and operational compliance. This role partners directly with internal stakeholders and external provider organizations to validate accuracy, identify risk, and drive resolution of audit findings.

The ideal candidate brings strong audit discipline, provider-facing communication skills, and the ability to explain findings clearly while maintaining productive provider relationships.

Key Responsibilities

Audit Execution & Analysis

Perform audits of provider-related data, and financial arrangements to validate compliance with contract terms, internal policies, and regulatory requirements.

Review and assess documentation, calculations, data sources, and system outputs related to Medical Economics processes.

Independently identify audit exceptions, root causes, and risk levels, ensuring findings are supported by clear evidence.

Apply defined audit criteria, scoring methodologies, and sampling approaches consistently across audits.

Provider & Network Engagement

Serve as a primary audit point of contact within MEU for provider groups, delegated vendors, and network partners when audit activity requires external coordination.

Communicate audit scope, findings, and remediation expectations clearly and professionally to external providers and internal network teams.

Participate in audit discussions that may involve sensitive financial or operational impacts, maintaining professionalism and objectivity.

Documentation, Reporting & Follow-Up

Document audit results, findings, and remediation actions in audit tools, trackers, and workpapers with a high level of accuracy and clarity.

Track findings through remediation and verification, escalating risks and delays as needed.

Contribute to audit summaries, trend reporting, and leadership-ready materials that support ongoing network quality improvement.

Required Qualifications

5+ years working expereince

Bachelor's degree or equivalent experience in healthcare administration, finance, business, economics, or a related field.

Experience performing audits, quality reviews, or compliance assessments within healthcare, payer operations, provider networks, or vendor management.

Ability to analyze data, documentation, and calculations to identify discrepancies and assess financial or compliance impact.

Demonstrated ability engaging with external partners or providers through clear written and verbal communications.

Demonstrated ability to manage multiple audits or workstreams while meeting deadlines.

Preferred Qualifications

Experience supporting Medical Economics, provider contracting, provider data, charge master, or network operations.

Familiarity with provider audit processes, data integrity reviews, or quality programs.

Experience documenting audit results in structured tools (e.g., Excel-based audit tools, trackers, or reporting systems).

Comfort working cross-functionally with Network Management, Hospitals and Ancillary facilities.

Advanced Excel skills (audit tracking, documentation, and reporting).

Education

BA degree

This remote role dos not support sponsorship at this time

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $145,860.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

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.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 06/15/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.

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