Senior Analyst, Corp Compliance

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

• 2+ years of experience in healthcare compliance, auditing, monitoring, billing, coding, claims review, medical record review, risk adjustment, investigations, or risk assessments within a healthcare organization, provider practice, health plan, or government healthcare program.
• Strong knowledge of CMS Medicare Part B and Part C requirements, Medicare Advantage risk adjustment programs, HCC coding, RAF methodologies, provider documentation standards, medical record validation, coding compliance requirements, and documentation support standards for billed services and submitted diagnosis codes.
• Experience reviewing medical records, claims data, diagnosis codes, modifiers, and supporting documentation to determine whether HCC submissions, RAF impact, billed services, and coding outcomes are accurate, complete, and supported.
• Strong analytical, deductive, problem solving, and critical thinking skills.
• Willingness to travel up to 5% (including by plane)

• Demonstrated ability to collaborate across Compliance, Legal, clinical operations, billing, coding, finance, and business teams to evaluate risk and support timely issue resolution.
• Ability to facilitate meetings and communicate information clearly in written and verbal form.
• Regular and reliable attendance is an essential function of the role.
• Perform additional responsibilities as assigned by the supervisor or manager.
• Ability to evaluate information, identify compliance risks, solve complex problems, and recommend practical solutions using sound judgment.
• Ability to identify opportunities to use automation and analytics to improve monitoring efficiency and provide actionable information to first-line business partners.
• Strong cross-functional communication and relationship-building skills, with the ability to communicate results to management and other stakeholders in a matrixed organization.
• Demonstrated ability to coordinate assigned activities, execute and document monitoring testing, and communicate results.
• Experience analyzing claims, encounter, billing, coding, and documentation data to identify trends, outliers, control gaps, and compliance risk.
• Strong business acumen, organizational and time management skills, and attention to detail, with the ability to synthesize compliance results and findings clearly.

• Bachelors Degree; equivalent work experience may substitute
• High School Diploma/GED required
• Certified Professional Coder (CPC) required

The typical pay range for this role is:

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.