Health Care QM Consultant- Fully Remote

Job Description
Processes and evaluates complex data and information sets (e.g. processes & procedures, ICD-10 coding, inpatient coding)
Performs quantitative and qualitative data analysis
Converts the results of data analysis into meaningful business information and reaches conclusions about the data
Prepares and completes QM documents based on interpretation and application of business requirements
Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements
Assists in the development and implementation of QM projects and activities
Accountable for completing and implementation of QM Work Plan Activities (e.g. QM committees, audits, clinical reviews,)
Prepares and reports business information to internal and external constituents and consults with constituents on solutions to business issues (e.g. delegates, committees, workgroups, regulators)

Required Qualifications
-Coding certifications required
-Extensive coding experience with ICD-10
-Clear written and verbal communication
-CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required
-CRC (Certified Risk Coder) preferred
-AHIMA Certification

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
-Experience with Microsoft Office products (Word, Excel, Project, PowerPoint, Outlook).
-Experience with ICD-10 codes required.
-Minimum of 4 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
-Experience with Medicare and/or Medicaid Risk Adjustment process required
-Excellent analytical and problem solving skills
-Effective communications, organizational, and interpersonal skills.

Coding Certification Required

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.