# Senior Analyst, Compliance COE

**Company**: CVS Health
**Experience**: senior
**Job type**: full-time
**Salary**: $46,988.00 - $112,200.00
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/RI---Work-from-home/Senior-Analyst--Corp-Compliance_R1064432?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_8d965497-3a3

## Description

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

The Senior Analyst, Compliance COE will be a key member of the Compliance Monitoring team and will execute assigned compliance monitoring activities.

**Responsibilities**

- Execute assigned compliance monitoring activities, applying healthcare compliance, billing, coding, and risk adjustment knowledge.

- Coordinate assigned monitoring activities, including results reporting, issue follow-up, and communication of compliance risks and business impacts.

- Review medical records, claims data, diagnosis codes, modifiers, and supporting documentation to determine whether HCC submissions, RAF impact, billed services, and coding outcomes are accurate, complete, and supported.

**Requirements**

- 2+ years of experience in healthcare compliance, auditing, monitoring, billing, coding, claims review, medical record review, risk adjustment, investigations, or risk assessments.

- Strong knowledge of CMS Medicare Part B and Part C requirements, Medicare Advantage risk adjustment programs, HCC coding, RAF methodologies, provider documentation standards, medical record validation, coding compliance requirements, and documentation support standards.

- Strong analytical, deductive, problem-solving, and critical thinking skills.

- Willingness to travel up to 5% (including by plane).

**Preferred Qualifications**

- Demonstrated ability to collaborate across Compliance, Legal, clinical operations, billing, coding, finance, and business teams.

- Ability to facilitate meetings and communicate information clearly in written and verbal form.

- Regular and reliable attendance.

- Perform additional responsibilities as assigned.

- Ability to evaluate information, identify compliance risks, solve complex problems, and recommend practical solutions.

**Education**

- Bachelor's Degree; equivalent work experience may substitute.

- High School Diploma/GED required.

- Certified Professional Coder (CPC) required.

**Benefits**

- Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.

## Skills

### Required
- CMS Medicare Part B and Part C requirements
- Medicare Advantage risk adjustment programs
- HCC coding
- RAF methodologies
- provider documentation standards
- medical record validation
- coding compliance requirements

### Nice to have
- collaboration
- communication
- analytical skills
- problem-solving
- critical thinking

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/RI---Work-from-home/Senior-Analyst--Corp-Compliance_R1064432?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)