at CVS Health in Chicago, Illinois, United States
Job Description
Job Description
Scheduled: Monday-Friday standard business hours with flexibility to work EST hours as needed to meet business needs.
Travel 25-50% in Chicago, IL.
Uses clinical skills to assess, plan, monitor, and evaluate healthcare services in the provider office setting – participating in direct patient care and assessment. Responsible for educating providers on how to properly
document medical services and interventions received during face-to-face member encounters, including proper coding and claim submission for services rendered. Works on-site in physician offices to assist with scheduling appointments for health risk assessments and other related medical services in support of our commercial exchange members who may
have a gap in care. Serves as a liaison to peers 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. Simultaneously
manages multiple, complex projects.
Position will potentially have minimal regional travel to Aetna’s provider offices, clinics, and facilities. Position requires proficiency with computer skills which includes
Pay Range
The typical pay range for this role is:
Minimum: 58,760
Maximum: 125,840
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
CPC (Certified Professional Coder) certification and CRC (Certified Risk Adjustment Coder) certification required.
-3+ years of experience with Medicare and/or Commercial risk adjustment process required.
-Valid Illinois drivers license
– Reliable transportation required
– Mileage is reimbursed per our company expense reimbursement policy
Preferred Qualifications
-Knowledge of quality of care and member safety issues
-Knowledge of regulatory/accreditory guidelines
-4+ years of recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
-Experience with ICD-10 codes preferred
-2+ years Experience/understanding of electronic medical records/electronic health records in the office setting required.
Education
High school diploma or GED
Bachelor’s degree preferred
Business Overview
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
