Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
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

•Acts as an advocate for, and support for the business. This is accomplished by serving as a champion through measuring and monitoring the quality and effectiveness of work processes, directly impacting customer satisfaction and operational efficiency.

•Consult and/or work cross functionally to influence and promote change to continually deliver quality service to our internal and external customers.

•Responsible for conducting highly complex quality management, procedural documentation, and/or special analysis audits and projects.

•Manages contractually required audits involving significant financial value and risk.

•Oversees multiple concurrent projects including planning, execution, evaluation and formulating corrective actions.

•Serves as subject matter expert in Quality Management, auditing practices, external audits, and internal audits.

•Serves as a leader to plan, organize, and facilitate multiple, concurrent projects of high complexity.

•Drafts the audit issues and reports for each assigned project that effectively communicates the purpose of the project and conclusions reached in a manner appropriate for senior leadership.

•Manages project resource needs, identifies, and communicates resource/administrative gaps, and works with department management to secure necessary resources to meet project objectives.

•Participates in department wide activities such as training and staff development as well as management presentations to other Aetna/CVS Health areas.

•Provides oversight in the completion of process improvements, for each project. Tests that interventions/solutions were effective in remediating and improving the quality of work for that which was in scope for the project.

•Works with business leadership and their staff as necessary to review project findings, draft solutions, track corrective action plans, and track the installation of improvement solutions.

Required Qualifications

• 3 years Risk Adjustment experience
• Preferably have an active RN, NP or PA License
• Active certified coder certification through AHIMA or AAPC required (CRC, CPC, CCS - P). CCA, CPC-A are not accepted
• At least one year of experience as a certified coder is required
• Experience with Medicare Advantage products
• Strong clinical knowledge related to chronic illness diagnosis, treatment, and management
• Reliability and a commitment to meeting tight deadlines

Personal discipline to work remotely without direct supervision.
Preferred Qualifications
•Should have significant project management experience within Medicare Advantage and ACA or related field.

•Ideally extensive experience with vendors that provide supplemental benefits. Audit or related business experience with insurance, demonstrating high proficiency in the competencies noted.

Education

• Bachelor’s Degree or relevant experience in lieu of degree.
• Preferred to have a degree in Public Health, Health Care Informatics, Risk Management, Insurance, or related field of study. Advanced degree preferred.

Pay Range

The typical pay range for this role is:

$54,300.00 - $145,860.00

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 Benefits | CVS Health

We anticipate the application window for this opening will close on: 11/02/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.