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Key business role that will be instrumental in performing pre-implementation data review and translation of new CXT and Cotiviti edit requests.Responsibilities include pre-implementation set up and validation of new edit installations (Testing and QA via ClaimLab for ClaimsXten bi-weekly updates). QA testing to validatePPM/CV edits are set up correctly prior to being sent to Cotiviti. Project implementation and new rule testing (ClaimsXten Dictionary,ClaimLab, Development, System, SQA, and UAT testing) (CCES/Novologix/CV/PPM/PCCV Claim Editing QA Process (Post ImplementationValidation via Daily Edit Recommendation Reviews). CV & PPM ACASRequired Qualifications:Certified Professional Coding Certification -within one year of hire date• Familiarity with clinical and code editing concepts (Example: Claim Check, ClaimsXten)• Extensive knowledge of CPT, HCPCS, ICD-10 coding• Ability to prioritize and work in a fast paced, deadline oriented environment• Excellent critical thinking skills• Analytical and creative problem-solving abilities• Experience with Outlook, Excel, and Word• Excellent verbal and written communication skills• Excellent listening and interpersonal skills• Desire to work in a team-oriented, collaborative environment• Must be willing to work 1-2 Sundays each month for content updatesPreferred QualificationsCPC helpful but not required.EducationBachelors degree or equivalent.Pay RangeThe typical pay range for this role is:$66,330.00 - $145,860.00This 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.In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 01/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
