CVS Health
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.
Program Integrity Auditor
Job not on LinkedIn
🕒 July 31
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CVS Health
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
• Serve as an audit team member for health plan(s) administering benefits to Medicaid members • Audit records on a routine basis for all lines of business • Coordinate audit documentation and reports for internal and external staff • Identify aberrant billing patterns and potential FWA • Assist with investigations and report to state regulators • Provide technical assistance and education to providers • Maintain compliance with company policies and procedures • Perform other duties as assigned
🎯 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
• health insurance • dental coverage • vision coverage • paid time off • retirement savings options • wellness programs
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