Senior Analyst, Corporate Compliance

Job not on LinkedIn

🕒 October 20

🦌 Connecticut, Illinois, +2 more states – Remote

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

💵 $47k - $112.2k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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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