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Role Description
The Coding Specialist is responsible for verifying and ensuring the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on the documentation and services rendered. The Coding Specialist will be expected to adhere to ICD-10-CM Official Guidelines and any internal guidelines that support accurate and complete capture of the patient’s holistic health picture.
• Review health risk assessments/evaluations to accurately and completely assign all ICD-10 codes that are clinically identified and supported in the assessment/evaluation on a timely basis
• Identify opportunities to query providers as necessary for clarification of documentation or conflict resolution to enable the proper application of ICD-10 HCC diagnosis codes
• Communicate timely and effectively with the supervisor regarding issues with the health risk assessments/evaluations and/or corrections required to the health risk assessments/evaluations
• Understand the relationship between ICD-10 coding and HCC (hierarchical condition category) coding
• Maintain adequate knowledge of coding, compliance, and reimbursement procedures related to Medicare Risk Adjustment
• Make recommendations for coding policy/changes
• Maintain coding certification after achieving certification status
• Complete special projects as assigned by management, which require defining problems, and implementing required changes
• Responsible for the security and privacy of all protected health information that may be accessed during normal work activities
Qualifications
• Must hold an active CPC, COC, CCS, CCS-P or CCA
• Current coding certification in good standing
• CRC preferred
• Minimum of 1 year of ICD-10 coding experience
• Prior work experience in the healthcare field specifically related to coding is preferred
• Experience and knowledge of Medicare, ACA Exchange or Medicaid HCC coding preferred
• Experience with medical record documentation
• Prior medical chart auditing/quality experience preferred
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology
Benefits
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• 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
Time Type
Full time
Pay Range
The typical pay range for this role is: $18.50 - $42.35. 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.