At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

The ideal candidate will coordinate the identification of potential claim editing & clinical program enhancements to ensure compliance with Federal and State Legislation. This individual will also provide Prepay DRG coding consultations to CCR nurses and other medical coding services on ACAS and HRP. Additionally, the successful candidate will collaborate and partner with functional leads and other business areas to ensure quality and end-to-end payment accuracy functions in the Federal/State legislation policy space. They will use DRG coding knowledge to provide Prepay DRG clinical coding consultations.

Skill in:

Effective Verbal and Written CommunicationCollaboration across various teams and levels

 

Ability to:

Experience performing legal and/or regulatory researchDemonstrated ability to review and understand various business operations in different settingsWork independently, as well as in collaboration with, colleagues from across organization to monitor compliance strategiesEscalate risks and identified issues timely to leadership and work towards meaningful solutions

Required Qualifications

Professional procedure code certification through recognized certifying entityMust be familiar with claim editing software to propose system changes and ensure claim editing accuracy

Preferred Qualifications

Healthcare Compliance experienceProficiency in ClaimsXten

Education

High school and equivalent work experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $102,000.00

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:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 10/02/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.