CVS Health

Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.. Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred.. CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required.. CRC (Certified Risk Adjustment Coder) preferred or certified within 6 months of employment.. Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on the job experience equal to approximately 3 years for CPC.

quality auditor

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
A Brief Overview
Administers product quality management strategy to meet established quality expectations and organizational objectives. Performs support functions for the Health Care Quality Management area. Conducts audits of medical records to ensure submission and documentation comply with government regulations and internal policies and procedures.

What you will do
Executes both routine and non-routine business support tasks for the Coding Data Quality area under limited supervision, referring deviations from standard practices to managers.
Follows area protocols, standards, and policies to provide effective and timely support.
Organizes educational initiatives for staff and providers based on audit findings.
Communicates the audit process and results to the appropriate departments and management.
Assists senior staff in providing recommendations for process improvements to achieve productivity and quality goals, and to enhance operational efficiency.
Takes direction to execute techniques, processes, and responsibilities.

For this role you will need Minimum Requirements
Working knowledge of problem solving and decision making skills
5+ years work experience
Position Summary
Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.

In this position you will have the opportunity to demonstrate proficiency in the following:

Proven ability to support coding judgment and decisions using industry standard evidence and tools.
Proficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other qualified healthcare providers in the office and/or facility setting.
Thorough grasp of anatomy, physiology and medical terminology to comprehend clinical documentation and code descriptions.
Sound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity.
Identify clinically active vs. historical conditions
Expertise in medical documentation requirements
Diagnosis codes must be appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.
Utilize medical records to ensure support is documented for etiology and manifestations of disease processes.
Ability to support coding judgment and decisions using industry standard evidence and tools.
Assists senior level staff in providing recommendations for process improvement so that productivity and quality goals can be met or exceeded, and operational efficiency and financial accuracy can be achieved.
Adhere to stringent timelines consistent with project deadlines and directives.
Must possess high level of dependability and ability to meet coding accuracy and production standards.
Monitors own work to help ensure quality.
Required to always act in ethical manner as required under HIPAA's Privacy and Security rules to handle patient data with uncompromised adherence to the law.
Performs other related duties as required.

Required Qualifications

Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications).
Experience with International Classification of Disease (ICD) codes required.
Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred.
CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required.
CRC (Certified Risk Adjustment Coder) preferred or certified within 6 months of employment.
Excellent analytical and problem-solving skills.

Minimum of 3 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
Demonstrated communication, organizational, and interpersonal skills.

Education
AA/AS or equivalent experience.
Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on the job experience equal to approximately 3 years for CPC.
Pay Range
The typical pay range for this role is:
$18.50 - $35.29
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
We anticipate the application window for this opening will close on: 03/25/2024
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.

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