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CVS Health
CVS Health
Asigurare de sănătateAsistență medicalăComerț cu amănuntul
CVS Health este o companie americană din domeniul sănătății, care activează în servicii medicale, asigurări de sănătate, gestionarea beneficiilor farmaceutice și farmacii cu vânzare cu amănuntul. Prin companii precum Aetna și CVS Caremark, aceasta sprijină acoperirea medicală, accesul la medicamente eliberate pe bază de rețetă, gestionarea afecțiunilor, medicamentele specializate și serviciile de farmacie prin comenzi prin poștă. Farmaciile sale de proximitate și serviciile extinse de îngrijire sunt concepute pentru a-i ajuta pe oameni să acceseze mai ușor și mai accesibil servicii medicale esențiale. CVS Health reunește asigurările, farmacia și serviciile de sănătate pentru a sprijini persoanele și comunitățile pe tot parcursul experienței lor de îngrijire.
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Locurile de muncă ale companiei

Senior Coding Quality Analyst, Special Investigations

Review coding quality for CVS Health’s Special Investigations Unit, assessing healthcare claims for accuracy and compliance. Identify potential billing errors, fraud, waste, abuse, and suspicious patterns.

USStatele Unite ale AmericiiMNMinnesota
46.988 $ – 102.000 $ / an
HibridNormă întreagăSeniorLimbă Obligatorie: englezăAnalist

Descriere

  • Review completed medical coding assessments for consistency with clinical records, CPT, HCPCS, and ICD-10 guidance, and payer, state, and federal rules.
  • Examine medical records tied to claims from medical, behavioral health, transportation, and other healthcare providers.
  • Assess data, records, and evidence for possible billing errors, abuse, fraud, and unusual billing patterns or trends.
  • Manage complex coding reviews related to legal and compliance matters, escalations, audits, and rework.
  • Document findings in detailed written reports and explain conclusions to leadership.
  • Research and apply state, CMS, and payer-specific rules to audits and reviews.
  • Spot opportunities to improve processes, reduce costs, and flag cases for prepayment review.
  • Keep documentation, records, files, and tracking logs accurate while meeting deadlines and performance targets.
  • Use departmental systems and workflows to support day-to-day operations.
  • Coach and train coders in quality, documentation standards, and review methods.
  • Step in for management and support team operations when the manager is absent.
  • Stay current on coding standards, compliance updates, reimbursement methods, and investigative practices.
  • Help improve investigative methods, tools, and processes.

Cerințe

  • AAPC CPC certification.
  • At least one year reviewing coding consultant decisions for quality.
  • At least one year developing and implementing quality remediation plans.
  • At least one year of medical coding experience in a fraud, waste, abuse, or error department.
  • Knowledge of standard coding references and guidelines, including CPT, HCPCS, and ICD-10.
  • Experience researching coding rules and policies.
  • Experience with Microsoft products, including Excel and Word.
  • GED or high school diploma.
  • CPMA certification preferred.
  • Excellent communication skills preferred.
  • Excellent analytical skills preferred.
  • Strong attention to detail and ability to review and interpret data preferred.

Beneficii

  • Medical coverage.
  • Dental coverage.
  • Vision coverage.
  • Paid time off.
  • Retirement savings options.
  • Wellness programs.
  • Resources supporting physical, emotional, and financial well-being.
  • Eligibility for CVS Health bonus, commission, or short-term incentive programs.

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