CVS Health
Health Care
AnalystSIUCertifiedCoder
“Analyst SIU Certified Coder at CVS Health. Skills: Medical Coding, Auditing, Compliance, Fraud Detection. Perform medical claim reviews. Ensure compliance with coding practices”
What You'll Achieve.
Meet metrics
Industry & Context.
ability to review and interpret data; Excellent analytical skills
What They're Looking For.
Must Have
AAPC Coding certification, 3+ years of experience in medical coding or documentation auditing, knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements, Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement, Experience with researching coding and policies, Experience with Microsoft Excel and Word, attention to detail and ability to review and interpret data, Demonstrates communication skills
Nice to Have
Prior auditing experience, Excellent communication skills, Excellent analytical skills, Two years or more previous experience with Behavioral Health coding/auditing of records
What You'll Do.
Perform medical claim reviews
Ensure compliance with coding practices
Determine correct coding and documentation
federal and company requirements are met
Recognize concerning billing patterns
Conduct medical record audit
Provide written summary of findings
Articulate findings to stakeholders
Research and apply state or CMS guidelines
Review and discuss cases with Medical Directors
Assist with investigative research
Identify potential billing errors
Identify opportunities for savings
Maintain appropriate records
Follow workflows to meet metrics
How You'll Work.
Team & Collaboration
Articulate findings to investigators; Articulate findings to Medicaid plan leadership; Articulate findings to law enforcement; Articulate findings to legal counsel; Articulate findings to providers; Articulate findings to state regulators; Review and discuss cases with Medical Directors
Communication Scope
Demonstrates communication skills; Excellent communication skills
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