Senior Quality Analyst

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. Role Overview 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. Contributes to compliance reporting and documentation, highlighting findings, recommendations, and areas of concern to be delivered to coding resources. Job Description Demonstrated ability to apply coding judgment and make decisions using industry-standard evidence and tools, exercising independent judgment to determine final outcomes prior to submission with minimal supervision. Adhere to stringent timelines consistent with project deadlines and directives. Demonstrates a strong commitment to enhancing and promoting quality; consistently delivers accurate and thorough work, and supports others in achieving the same standards through effective mentoring and instruction. Serves as the training resource and subject matter expert to vendors, providers and other team members for questions regarding ICD coding and documentation requirements. Comprehensive knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity. Identify and communicate documentation deficiencies to allow for continuous education opportunities for providers, vendors and peers. Expertise in medical documentatio...