Senior Compliance Analyst Medicare Risk & Coding

CVS Health; Providence (RI); Vor Ort; USD 47.000 - 112.000; Vollzeit

Zusammenfassung

CVS Health in Providence, RI is seeking a Senior Analyst, Compliance COE to execute assigned compliance monitoring activities across multiple business areas. You will apply healthcare compliance, billing, coding, and risk adjustment knowledge to assess RAF impact and reporting.

The role requires strong Medicare knowledge, experience with medical record validation, and the ability to coordinate results, follow up on issues, and communicate risks to leadership. Travel up to 5% may be required.

Qualifikationen

• 2+ years of experience in healthcare compliance, auditing, monitoring, billing, coding, or related areas.
• Strong knowledge of CMS Medicare Part B and Part C, HCC coding, and RAF methodologies.
• Experience reviewing medical records and claims data to assess RAF impact and coding outcomes.
• Strong analytical and problem-solving skills.
• Willingness to travel up to 5%.

Aufgaben

• Execute assigned compliance monitoring activities across multiple business areas.
• Coordinate monitoring activities, report results, and follow up on issues.
• Communicate compliance risks and business impacts to stakeholders.

Kenntnisse

Analytical thinking

Problem solving

Critical thinking

Willingness to travel

Ausbildung

Bachelor's Degree

High School Diploma/GED

Certified Professional Coder (CPC)

Jobbeschreibung

CVS Health in Providence, RI is seeking a Senior Analyst, Compliance COE to execute assigned compliance monitoring activities across multiple business areas. You will apply healthcare compliance, billing, coding, and risk adjustment knowledge to assess RAF impact and reporting.

The role requires strong Medicare knowledge, experience with medical record validation, and the ability to coordinate results, follow up on issues, and communicate risks to leadership. Travel up to 5% may be required.