[Hiring] Coding Specialist @CVS Health

Role Description

Under the supervision of the Manager of Coding, this position is responsible for ICD-10 coding of Health Risk Evaluations of Medicare and Medicaid members that are performed by the Signify Health physicians and reviewing the Health Risk Assessments/Evaluations to ensure completeness, accuracy, and compliance with CMS guidelines.

• Reviews health risk assessments/evaluations to determine completion and compliance with CMS guidelines on a timely basis.
• Reviews and assesses the accuracy, completeness, specificity, and appropriateness of diagnosis codes identified in the health risk assessments/evaluations.
• Reviews health risk assessments/evaluations to accurately and completely assign all ICD-9/10 codes that are clinically identified and supported in the assessment/evaluation on a timely basis.
• Communicates timely and effectively with supervisor regarding issues with the health risk assessments/evaluations and/or corrections required to the health risk assessments/evaluations.
• Understands the relationship between ICD-9/10 coding and HCC (hierarchical condition category) coding.
• Utilizes advanced, specialized knowledge of medical codes and coding protocol by providing guidance to the Director of Coding to ensure the organization is following Medicare coding protocol for payment of claims.
• Demonstrates a commitment to integrating coding compliance standards into coding practices. Identifies, corrects, and reports coding problems.
• Maintains adequate knowledge of compliant coding procedures related to Medicare Risk Adjustment.
• Maintains coding credentials.
• Completes special projects as assigned by management, which require defining problems and implementing required changes.
• Follows all legal and policy requirements for HIPAA protected data.
• Actively demonstrates teamwork at all times.
• Ability to work overtime.
• Is able to meet and maintain required accuracy and efficiency standards.

Qualifications

• Must hold an active CPC, CPC-A, COC, CCS, CCS-P or CCA.
• Current coding certification in good standing.
• CRC required.
• ICD-10 Coding Certification will be required.
• Minimum of 1 year of experience in ICD-10 coding.
• Prior work experience in the healthcare field specifically related to coding is preferred.
• Experience and knowledge of Medicare HCC coding.
• Experience with medical record documentation.
• Prior medical chart auditing/quality experience preferred.
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.

Requirements

• Ability to work overtime.
• Is able to meet and maintain required accuracy and efficiency standards.

Benefits

• Eligible employees may enroll in a full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan.
• Education assistance.
• Free development courses.
• Paid time off programs.
• Paid holidays.
• CVS store discount.
• Discount programs with participating partners.