Description
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 - $35.29This 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](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 04/29/2024
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