Quality Senior Analyst, CVS Health

CVS Health

Location:
United States

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

46988.00 - 112200.00 USD / Year

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Job Description:

Responsible for conducting complex audits, reviews and assessments of medical records coded by internal teams prior to the submission to the Centers of Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.

Job Responsibility:

Conducting complex audits, reviews and assessments of medical records coded by internal teams prior to submission to CMS for risk adjustment processes
Contributes to compliance reporting and documentation, highlighting findings, recommendations, and areas of concern
Adhere to stringent timelines consistent with project deadlines and directives
Serves as training resource and subject matter expert to vendors, providers and other team members for questions regarding ICD coding and documentation requirements
Identify and communicate documentation deficiencies to allow for continuous education opportunities

Requirements:

Minimum of 5 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing
Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required
Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on the job experience equal to approximately 5 years for CPC
CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment Coder) required
CPMA (Certified Professional Medical Auditor) or CDEO (Certified Documentation Expert Outpatient) preferred

Nice to have:

Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications)
Experience with International Classification of Disease (ICD) codes required
Expertise in medical documentation, fraud, abuse and penalties for documentation and coding violations based on governmental guidelines

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
October 04, 2025

Expiration:
October 13, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Quality Senior Analyst