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Job Description
Primary Job Duties & Responsibilities:
Reviews health risk assessments/evaluations to determine completion and compliance with CMS guidelines on a timely basis. Reviews and assesses the accuracy, completeness, specificity and appropriateness of diagnosis codes identified in the health risk assessments/evaluations. Reviews health risk assessments/evaluations to accurately and completely assign all ICD-9/10 codes that are clinically identified and supported in the assessment/evaluation on a timely basis. Communicates timely and effectively with supervisor regarding issues with the health risk assessments/evaluations and/or corrections required to the health risk assessments/evaluations. Understanding the relationship between IC-9/10 coding and HCC (hierarchical condition category) coding. Utilizes advanced, specialized knowledge of medical codes and coding protocol by providing guidance to the Director of Coding to ensure the organization is following Medicare coding protocol for payment of claims. Demonstrate a commitment to integrating coding compliance standard into coding practices. Identify, correct and report coding problems. Maintain adequate knowledge of compliant coding procedures related to Medicare Risk Adjustment. Maintain coding credentials. Complete special projects as assigned by management, which require defining problems, and implementing required changes. Follows all legal and policy requirements for HIPAA protected data.
Education: High School Diploma or equivalent
Experience: 2 to 5 years of prior relevant experience. Minimum of 1 year of experience of ICD-10 coding.
Essential Qualifications:
Must hold an active CPC, CPC-A, COC, CCS, CCS-P or CCA. Current coding certification in good standing. CRC required. ICD-10 Coding Certification will be required. Experience and knowledge of Medicare HCC coding. Experience with medical record documentation. Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.
Anticipated Weekly Hours: 40
Time Type: Full time
Pay Range: The typical pay range for this role is: $18.50 - $35.29
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
We anticipate the application window for this opening will close on: 07/18/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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