Job Information
CVS Health QM Nurse Consultant in Harrisburg, Pennsylvania
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
This position supports accurate claim payment through identification of disallowed billed charges through Internal Itemized Bill Review. This Nurse Coder position reviews hospital itemized bills to determine if all billed charges are appropriate including but not limited to the charges for a single line item (i.e. single line expense). By utilizing both internal payment policies and Medicare payment policies the Nurse Coder ensures all billed line items align with these policies.
Fundamental Components:
Utilize clinical skills to identify disallowed billed charges during review of routine to complex high dollar facility claims.
Communicate with various levels of Network Management and Claims teams.
Consult with external supplier for review of application of findings
Collaborate with team members to identify opportunities for process improvement and optimization.
Participate in the planning of adding new plan sponsors to the program.
Consult and lend expertise to other internal and external constituents as requested by investigating, analyzing, and responding to issues as requested.
Maintain production and claims quality standard while working on special projects.
Required Qualifications
3-5 years of clinical experience required.
Familiarity with facility claims and billing
Effective communication skills, both verbal and written with both internal and external constituents
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Ability perform close inspection of hand written and computer generated documents
ACAS claim system knowledge
Education
- RN with current unrestricted state licensure.
Pay Range
The typical pay range for this role is:
$60,522.80 - $129,600.00
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. 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 jobs.CVSHealth.com/benefits
We anticipate the application window for this opening will close on: 06/06/2024
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.