Required Qualifications

• A minimum of 3 years of experience in healthcare within auditing, compliance, or fraud, waste and abuse.
• Knowledge of CPT/HCPCS/ICD coding.
• Proficiency in Microsoft Word, Excel, Outlook, database search tools, and internet research.
• Willingness to travel and participate in legal proceedings, arbitrations, depositions, etc.

Preferred Qualifications

• Credentials such as a certification from the Association of Certified Fraud Examiners (CFE), an accreditation from the National Health Care Anti-Fraud Association (AHFI), or a minimum of three years of Medicaid Fraud, Waste, and Abuse review experience.
• Billing and Coding certifications such as CPC (AAPC) and/or CCS (AHIMA).
• Knowledge of Behavioral Health policies and procedures is a plus.
• Experience reviewing Behavioral Health fraud cases.
• Understanding of clinical issues related to healthcare.
• Strong communication and customer service skills.
• Ability to effectively interact with diverse groups of people at various levels in any situation.
• Strong analytical and research skills using healthcare data.
• Proficient in researching information and identifying relevant resources.

Education

• A Bachelors degree or three years of experience in healthcare fraud, waste, and abuse investigations and audits.

Pay Range

The typical pay range for this role is:

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 Benefits | CVS Health

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.