CVS Health
10,000+ employees
Founded 1963
⚕️ Healthcare Insurance
🛒 Retail
🧘 Wellness
Healthcare Insurance • Retail • Wellness
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.
Analyst, SIU Certified Coder
Job not on LinkedIn
🕒 May 22
🦌 Connecticut – Remote
💵 $43.9k - $93.6k / year
⏰ Full Time
🟡 Mid-level
🟠 Senior
🏥 Medical Billing and Coding
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CVS Health
10,000+ employees
Founded 1963
⚕️ Healthcare Insurance
🛒 Retail
🧘 Wellness
Healthcare Insurance • Retail • Wellness
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
• Perform medical claim reviews for the Special Investigations Unit (SIU) • Conduct a comprehensive medical record audit to ensure compliance with coding practices • Provide detailed written summary of medical record review findings • Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc. • Research and accurately apply state or CMS guidelines related to the audit • Review and discuss cases with Medical Directors to validate decisions • Assist with investigative research related to coding questions, state and federal policies • Identify potential billing errors, abuse, and fraud • Identify opportunities for savings related to potential cases which may warrant a prepayment review • Maintain appropriate records, files, documentation
🎯 Requirements
• AAPC Coding certification • 3+ years of experience in medical coding or documentation auditing • Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10 • CMS 1500 and UB04 data elements • Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement • Experience with researching coding and policies • Experience with Microsoft products; Excel and Word • Strong attention to detail and ability to review and interpret data • Demonstrates strong communication skills
🏖️ Benefits
• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs
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