• Job Description

  Req#: R0384021

  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.

  Position Summary

  Shift Monday-Friday standard business hours. No holidays and no weekends.

  Fully remote in the USA.

  
  Uses clinical skills to assess, plan, monitor, and evaluate healthcare services in the provider office setting - participating in direct patient care and assessment. Responsible for educating providers on how to properly document medical services and interventions during chart reviews including proper coding and claim submission for services rendered. Serves as a liaison to peers to provide in-depth clinical knowledge and expertise to support the education of providers. Performs audits of medical records to ensure all assigned ICD-10 codes are accurate and supported by written clinical documentation. Identifies barriers utilizing critical thinking skills to identify improvement opportunities, communicate them to the national team, and help facilitate gains in efficiency and appropriate risk score capture. Leads work groups to develop learning strategies to improve health care delivery performance. Serves as the training resource and subject matter expert to regionally aligned network practices. Identifies and recommends opportunities for process improvements at the practice level to improve overall risk adjustment scores and gaps. Identifies opportunities to promote quality. Shares best practices in risk adjustment across all sites/regions. Simultaneously manages multiple, complex projects.

  Position will potentially have minimal regional travel to CVS ACO REACH provider offices, clinics, and facilities. Position requires proficiency with computer skills.
  
  Required Qualifications
  - CPC certification
  - 3+ years risk adjustment experience in Medicare advantage or commercial
  - 3+ years of provider education experience
  - Knowledge of regulatory/accreditor guidelines
  - 3+ years of recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
  - 3+ years experience with ICD-10 codes
  - 3+ years experience/understanding of electronic medical records/electronic health records in the office setting required.
  
  Preferred Qualifications
  - CPC certification
  - CRC certification
  - CPMA certification
  - CIC certification
  
  Education
  High school diploma or GED
  Bachelor's degree or equivalent work experience

  Pay Range

  The typical pay range for this role is:

  $54,095.60 - $116,760.80

  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 Benefits | CVS Health

  We anticipate the application window for this opening will close on: 10/03/2024

  Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

• About the company

  At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.

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