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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
Use clinical documentation skills to assess, plan, monitor, and evaluate healthcare services from 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 and to the Health Risk Educators that are out in the field 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.
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Manages multiple, complex projects and oversite of Health Risk Educators:
• Perform prospective and retrospective chart reviews
• 2nd level reviews for quality control on HRs prospective and retrospective chart reviews
• Prepare/review onsite materials
• Maintain HRE onsite/virtual schedule
• Collect after visit summary from HRE
• Communicate any issues that may arise with the Sr. Manager and work towards solutions to remove barriers
• Create and maintain job aids
• Track HRE quality and production metrics for measurable outcomes
• Stay informed of CMS changes as it relates to ACO Reach program
• Identify staffing needs to support market initiatives
Position will potentially have minimal regional travel to CVS ACO REACH provider offices, clinics, and facilities. Position requires proficiency with computer skills which includes
Required Qualifications
- CPC certification
- 7 - 10+ years risk adjustment experience in Medicare advantage or commercial
- 7 - 10+ years of provider education experience
- Knowledge of regulatory/accreditor guidelines
- 7 - 10+ years of recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
- 7 - 10+ years experience with ICD-10 codes
- 7 - 10+ years experience/understanding of electronic medical records/electronic health records in the office setting required.
- Management/Supervisory experience
Preferred Qualifications
- CPC certification
- CRC certification
- CPMA certification
- CIC certification
Education
High school diploma or GED
Bachelor's degree and/or relevant work experience preferred
Pay Range
The typical pay range for this role is:
$60,300.00 - $132,600.00
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 jobs.CVSHealth.com/benefits
We anticipate the application window for this opening will close on: 04/15/2024
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.