Senior Quality Analyst

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🔥 0 minutes ago

🏈 Alabama, Connecticut, +2 more states – Remote

🏈 Alabama – Remote 🦌 Connecticut – Remote 🌽 Illinois – Remote 🏈 Ohio – Remote

💵 $47k - $112.2k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

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CVS Health

WebsiteLinkedInAll Job Openings

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

• Responsible for conducting complex audits, reviews and assessments of medical records coded by internal teams prior to submission to the Centers of Medicare and Medicaid Services (CMS). • Contributes to compliance reporting and documentation, highlighting findings, recommendations, and areas of concern to be delivered to coding resources. • Adhere to stringent timelines consistent with project deadlines and directives. • Demonstrates a strong commitment to enhancing and promoting quality; consistently delivers accurate and thorough work, and supports others in achieving the same standards through effective mentoring and instruction. • Serves as the training resource and subject matter expert to vendors, providers and other team members for questions regarding ICD coding and documentation requirements.

🎯 Requirements

• Minimum of 5 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing. • Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required. • Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on the job experience equal to approximately 5 years for CPC. • CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment Coder) required. • Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook). • Experience with International Classification of Disease (ICD) codes required. • Expertise in medical documentation, fraud, abuse and penalties for documentation and coding violations based on governmental guidelines.

🏖️ Benefits

• Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Comprehensive benefits package