Manager, Quality (IC)-Work at home anywhere in the U.S.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryAetna's Revenue Integrity team is hiring Manager, Quality (IC) to support our growing risk adjustment efforts.Manages operations pertaining to the preparation and delivery of required communication to leadership, coding professionals, and vendors consistent with regulations by Centers for Medicare and Medicaid Services (CMS), Health and Human Services (HHS) for the purpose of risk adjustment.Implements effective analysis to assess deficiencies in audit reviews and make recommendations for improvement.Develops audit processes to oversee and conduct complex investigations of deficiencies resulting in errors in audits to rectify mistakes and advance daily operations.Improves audit analysis processes by employing analytics.Identifies and recommends opportunities for process improvements so that productivity and quality goals are met or exceeded and operational efficiency with final accuracy is achieved.Serves as a subject matter expert regarding business audit operations informing management of planning and development in the department by improving audit analysis processes while employing analytics.Serves as the training resource and subject matter expert to vendors, providers and other team members for questions regarding ICD coding and documentation requirements.Helps establish and implement educational business audit programs to continually develop the skills of the department and assist with specific project and onboard training.Establishes and maintains relationships with coders and analysts, business departments, and staff to share information to both identify and progress current and future audit operations.Ability to work independently as well as in a cross functional role within other teams for collaboration on best practices.Adhere to stringent timelines consistent with project deadlines and directives.Required to act in ethical manner at all times as required under HIPAA's Privacy and Security rules to handle patient data with uncompromised adherence to the law.Thorough knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity.Provides education to internal staff including leadership on quality improvement methodologies, data collection techniques, and reporting requirements.Conducts oversite of process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body.Expertise in assigning accurate medical codes for diagnoses as documented for physicians and other qualified healthcare providers in the office and/or facility setting.Position can work at home anywhere in the United StatesRequired Qualifications3 years experience in the healthcare industry.5-7 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.Minimum 3 years encompassing additional credentials and/or application of credentials.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) required.CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment Coder) required.Position can work at home anywhere in the United StatesPreferred QualificationsComputer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications).

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.