Health Services - Certified Professional Coder (CPC)
About The Position
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This position is remote, applicants can reside in any state within the US This position REQUIRES a CPC. Position Summary The ideal candidate will coordinate the identification of potential claim editing & clinical program enhancements to ensure compliance with Medicare NCDs and LCDs as well as Federal and State Legislation. This individual will also collaborate and partner with functional leads and other business areas to ensure quality and end-to-end payment accuracy functions in the Medicare NCD/LCD and Federal/State legislation policy space. They will provide support and management, as needed, of savings opportunities and provider/customer deviation implementation.
Requirements
- Certified Professional Coder (CPC)
- 3+ years processing and/or researching claims for appropriate claim editing
- 3+ years experience in successfully meeting project deliverables
- 5+ years in Managed Care/Healthcare experience
- Effective Verbal and Written Communication
- Collaboration across various teams and levels
- Experience performing legal and/or regulatory research
- Manage multiple projects simultaneously, displaying strong organizational skills
- Demonstrated ability to review and understand various business operations in different settings
- Work independently, as well as in collaboration with, colleagues from across organization to monitor compliance strategies
- Escalate risks and identified issues timely to leadership and work towards meaningful solutions
- High school Diploma Required
Nice To Haves
- Current Registered Nurse (RN)
- Compliance Program Guidelines including CMS Medicare NCD/LCD, Federal, and State Legislation experience
- Medicare Rules and Regulations
- Healthcare Compliance experience
- Proficiency in ClaimsXten
- Bachelors Preferred
Responsibilities
- Coordinate the identification of potential claim editing & clinical program enhancements to ensure compliance with Medicare NCDs and LCDs as well as Federal and State Legislation.
- Collaborate and partner with functional leads and other business areas to ensure quality and end-to-end payment accuracy functions in the Medicare NCD/LCD and Federal/State legislation policy space.
- Provide support and management, as needed, of savings opportunities and provider/customer deviation implementation.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
