Senior Analyst, Corporate Compliance

Vaga não está no LinkedIn

🕒 Outubro 20

🦌 Connecticut, Illinois, +2 estados a mais – Remoto

🦌 Connecticut – Remote 🌽 Illinois – Remote ⚓ Rhode Island – Remote 🤠 Texas – Remote

💵 $46.988 - $112.200 / ano

⏰ Tempo Integral

🟠 Sênior

🚔 Conformidade

👻 Score fantasma 0%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 21 dias.
• As vagas desta empresa costumam ser preenchidas em 21 dias.

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CVS Health

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1963

🏥 Saúde

⚕️ Seguro de Saúde

🛒 Varejo

Healthcare • Healthcare Insurance • Retail

CVS Health é uma empresa líder de saúde nos Estados Unidos, dedicada a ampliar o acesso e a acessibilidade ao cuidado. A empresa adota uma abordagem abrangente que inclui serviços de saúde, seguro saúde e gestão de benefícios farmacêuticos (PBM). Por meio de suas subsidiárias, como Aetna e CVS Caremark, a CVS Health oferece uma variedade de serviços que promovem o bem-estar, a gestão de condições de saúde e a cobertura acessível de medicamentos prescritos. A CVS Health opera farmácias de bairro, oferece serviços de farmácia por correspondência e gerencia programas de medicamentos de especialidade, com o objetivo de tornar o cuidado com a saúde conveniente e acessível para todos. Movida pela missão de conectar pessoas a serviços essenciais de cuidado, a CVS Health está comprometida em fomentar comunidades mais saudáveis e apoiar o bem-estar de todas as pessoas.

Descrição

• Execute assigned healthcare compliance monitoring activities • Apply healthcare compliance, billing, coding, and risk adjustment knowledge to complex or concurrent reviews across multiple business areas • Coordinate assigned monitoring activities • Report results and follow up on identified issues • Communicate compliance risks and business impacts • Review medical records, claims data, diagnosis codes, modifiers, and supporting documentation • Evaluate the accuracy, completeness, and support of HCC submissions, RAF impact, billed services, and coding outcomes • Collaborate with Compliance, Legal, clinical operations, billing, coding, finance, and business teams • Facilitate meetings and communicate information to management and stakeholders • Execute and document monitoring testing • Analyze claims, encounter, billing, coding, and documentation data to identify trends, outliers, control gaps, and compliance risks • Recommend practical solutions and identify opportunities for automation and analytics

🎯 Requisitos

• 2+ years of experience in healthcare compliance, auditing, monitoring, billing, coding, claims review, medical record review, risk adjustment, investigations, or risk assessments within a healthcare organization, provider practice, health plan, or government healthcare program • Strong knowledge of CMS Medicare Part B and Part C requirements • Strong knowledge of Medicare Advantage risk adjustment programs, HCC coding, RAF methodologies, provider documentation standards, medical record validation, coding compliance requirements, and documentation support standards • Experience reviewing medical records, claims data, diagnosis codes, modifiers, and supporting documentation • Strong analytical, deductive, problem solving, and critical thinking skills • Willingness to travel up to 5% (including by plane) • Ability to collaborate across Compliance, Legal, clinical operations, billing, coding, finance, and business teams • Ability to facilitate meetings and communicate clearly in written and verbal form • Regular and reliable attendance is an essential function of the role • Ability to evaluate information, identify compliance risks, solve complex problems, and recommend practical solutions • Ability to identify opportunities to use automation and analytics to improve monitoring efficiency • Strong cross-functional communication and relationship-building skills • Ability to coordinate activities, execute and document monitoring testing, and communicate results • Experience analyzing claims, encounter, billing, coding, and documentation data • Strong business acumen, organizational and time management skills, and attention to detail • Bachelor's Degree; equivalent work experience may substitute • High School Diploma/GED required • Certified Professional Coder (CPC) required

🏖️ Benefícios

• CVS Health bonus, commission or short-term incentive program in addition to base pay • 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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