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.
Program Integrity Auditor
Job not on LinkedIn
🔥 3 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
• serve as an audit team member for a health plan administering benefits to Medicaid members • audit records on a routine basis to ensure coding and documentation meet regulatory standards • coordinate audit documentation and reports for review • identify aberrant billing patterns and potential fraud, waste, and abuse • assist with the development plan for prospective and retrospective fraud avoidance
🎯 Requirements
• 3-5 years of experience in reviewing and interpreting claims data • 3-5 years of experience with standard industry coding guidelines such as CPT, HCPCs, and ICD-10 • willingness to work Monday-Friday from 8am-5pm Arizona Time Zone • must possess an active CPC (Certified Professional Coder), CCS (Certified Coding Specialist), or CPMA (Certified Professional Medical Auditor) license
🏖️ Benefits
• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility
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