CVS Health

Mažmeninė prekyba Sveikatos draudimas Sveikatos priežiūra

CVS Health yra Jungtinių Amerikos Valstijų sveikatos priežiūros įmonė, veikianti sveikatos priežiūros paslaugų, sveikatos draudimo, vaistų išmokų administravimo ir mažmeninės prekybos vaistais srityse. Per tokias veiklas kaip „Aetna“ ir „CVS Caremark“ įmonė padeda užtikrinti sveikatos draudimo apsaugą, receptinių vaistų prieinamumą, ligų valdymą, specializuotus vaistus ir vaistų užsakymo paštu paslaugas. Jos vietinės vaistinės ir platesnės priežiūros paslaugos skirtos tam, kad žmonės galėtų patogiau ir prieinamiau gauti būtiną sveikatos priežiūrą. CVS Health sujungia draudimo, vaistinių ir sveikatos priežiūros paslaugas, kad padėtų žmonėms ir bendruomenėms viso jų priežiūros kelio metu.

Darbai įmonėje

Remote Medical Coding Quality Auditor at CVS Health

Review medical records, validate ICD risk-adjustment diagnoses, and support compliance with CMS requirements at CVS Health. This U.S.-remote position calls for a coding certification and relevant medical-record auditing experience.

prieš 1 valandą

18 $ – 38 $ / valanda

Nuotolinis Visas etatas Jaunesnysis specialistas Privaloma Kalba: anglų Auditorius

Aprašymas

Review provider and vendor medical records and identify ICD codes submitted to CMS.
Check risk-adjustment codes for accuracy, supporting documentation, and compliance with applicable regulations and company policies.
Use industry-standard evidence and tools to support coding decisions.
Assign accurate medical codes to diagnoses documented by physicians and other qualified healthcare providers.
Follow coding rules and regulations, including medical-necessity requirements.
Distinguish active clinical conditions from historical ones.
Confirm that diagnosis codes are appropriate, accurate, and supported by clinical records.
Check whether records support the documented disease causes and manifestations.
Complete work within project deadlines and assigned timelines.
Audit your own work for compliance with company policies and guidance from CMS, OIG, and other regulators.
Handle patient information ethically and in keeping with HIPAA requirements.
Carry out other related duties as needed.

Reikalavimai

Hold a CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) credential.
Be proficient with computers, Microsoft Office applications (Word, Excel, Access, PowerPoint, Outlook), and standard coding software.
Be able to place outbound calls and send faxes to providers.
Have experience using International Classification of Diseases (ICD) codes.
Have at least one year of recent, relevant experience reviewing medical-record documentation, coding diagnoses, and/or auditing.
Have an AA/AS degree or equivalent experience.
Complete an AAPC or AHIMA training program for a core credential (CPC or CCS-P), with related work history or on-the-job experience equivalent to approximately 1–2 years for CPC.
Know medical terminology and anatomy across all body systems.
Understand the audit process for risk-adjustment models.
Be able to follow HIPAA Privacy and Security rules and applicable regulations.
Preferred: Have three years of recent, relevant experience reviewing medical-record documentation, coding diagnoses, and/or auditing.
Preferred: Have experience with Medicare, commercial, and/or Medicaid risk-adjustment processes and Hierarchical Condition Categories.
Preferred: Hold a CPMA, CDEO, or CPC-I certification.
Preferred: Bring strong analytical, problem-solving, communication, organizational, and interpersonal skills.

Privalumai

May be eligible for a CVS Health bonus, commission, or short-term incentive in addition to base pay.
Medical coverage.
Dental coverage.
Vision coverage.
Paid time off.
Retirement savings options.
Wellness programs.
Resources for physical, emotional, and financial well-being.