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.
Senior Analyst, Fraud, Waste and Abuse Investigation
Job not on LinkedIn
🔥 13 hours ago
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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
• Leverage analytical skills to review claims data and identify patterns of suspected potential FWA. • Assist in the triage, preliminary investigation of all internal and external FWA complaints • Refer all cases of suspected FWA to regulatory agencies within required timeframes. • Assist in the monitoring of the FWA hotline and FWA shared email box • Participate in the prepayment review process including detailed review of medical records against claims data
🎯 Requirements
• 3-5 years’ work experience • CPC or equivalent coding certification • Working knowledge of standard industry coding guidelines such as CPT, HCPCs, ICD-10 • Experience reviewing medical records to ensure that documentation matches services billed • Experience reviewing detailed data to interpret claims data
🏖️ Benefits
• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources
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