[Remote] Analyst, Coding Data Quality Auditor at CVS Health

United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health SolutionsIndustries

Requirements

Proven experience in medical record auditing, preferably in a coding or healthcare setting
Strong knowledge of ICD-10 coding guidelines and regulations
Ability to work independently and in a cross-functional role
Excellent communication and interpersonal skills
Ability to identify and communicate documentation deficiencies
Experience with risk adjustment models and CMS documentation requirements
Strong understanding of medical terminology and anatomy
Ability to work with vendors, providers, and other team members to resolve coding issues
Familiarity with AHA Coding Clinic guidance and ICD coding
Ability to remain current on educational training and requirements

Responsibilities

Conduct process audits to ensure compliance with internal policies and procedures and existing CMS regulations
Identify and recommend opportunities for process improvements to increase productivity and quality
Lead dispute resolution and mentor internal staff to provide education on ICD codes
Communicate audit process and results to appropriate departments and management
Conduct medical record auditing and abstraction expertise
Assign accurate medical codes for diagnoses as documented for physicians and other qualified healthcare providers
Identify and communicate documentation deficiencies to allow for continuous education opportunities
Develop and implement process improvements to increase operational efficiency and accuracy
Collaborate with cross-functional teams to resolve coding issues
Remain current on educational training and requirements, including ICD coding, CMS documentation requirements, and State and Federal regulations

Skills

ICD-10 Coding

Auditing

Data Quality

Risk Adjustment

Communication

Problem-Solving

Process Improvement

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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