at CVS Health in Chicago, Illinois, United States
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
The typical pay range for this role is:
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.
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
-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.
High school diploma or GED
Bachelor’s degree preferred
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