Medicare Risk & HCC Compliance Analyst

CVS Health; Bristol (RI); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Senior Analyst, Compliance COE to join the Compliance Monitoring team. You will execute monitoring activities with healthcare compliance, billing, coding, and risk adjustment expertise across multiple business areas, focusing on Medicare Advantage and RAF methodologies.

The role requires strong analytical skills, the ability to travel up to 5%, and a CPC certification; a bachelor’s degree or equivalent is required.

Qualifications

• 2+ years in healthcare compliance, auditing, monitoring or related areas within a healthcare setting.
• Strong knowledge of CMS Part B/Part C Medicare Advantage, HCC coding and RAF methods.
• Experience reviewing medical records and claims to verify HCC submissions and coding outcomes.
• Willingness to travel up to 5% and collaborate across multiple teams.

Responsibilities

• Execute assigned compliance monitoring activities and coordinate testing.
• Report results, follow up on issues, and communicate risks and impacts.
• Apply knowledge of billing, coding, and risk adjustment to reviews.
• Collaborate with Compliance, Legal, billing, coding and finance teams.

Skills

Healthcare compliance

CMS Medicare knowledge

HCC coding

Analytical skills

Travel up to 5%

Education

Bachelor's Degree

High School Diploma/GED

Certified Professional Coder (CPC)

Job description

CVS Health is seeking a Senior Analyst, Compliance COE to join the Compliance Monitoring team. You will execute monitoring activities with healthcare compliance, billing, coding, and risk adjustment expertise across multiple business areas, focusing on Medicare Advantage and RAF methodologies.

The role requires strong analytical skills, the ability to travel up to 5%, and a CPC certification; a bachelor’s degree or equivalent is required.