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CVS Health Certified Professional Coder in Connecticut

Job Description

Perform clinical/coding medical claim review to ensure compliance with coding practices through a comprehensive review and analysis of medical claims, medical records, claims history, state regulations, contractual obligations, corporate policies and procedures and guidelines established by the American Medical Association and the Centers for Medicare and Medicaid Services.• Review medical records to ensure billing is consistent with medical record for appeals, adjustments and miscellaneous/unlisted code review.• Provide detailed summary of medical record review findings.• Be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, providers, state regulators, etc.• Review and discuss cases with Medical Director to validate decisions.• Assist with research of health plan coding questions.• Identify potential billing errors, abuse, and fraud.• Identify opportunities to flag potential cases which may warrant a prepayment review.• Maintain appropriate records, files, documentation, etc

Required Qualifications

AAPC Coding certification and 2+ years of experience in medical billing & coding.Experience with Microsoft products,

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

3-5 years Medicaid or Medicare Experience3-5 years Healthcare Insurance ExperienceExperience with researching coding and policies.Experience with Microsoft ExcelExcellent communication skillsExcellent analytical skills

Education

Associate’s degree in related field or equivalent experience.

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.

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