Special Investigation Unit Coding Director (Aetna SIU)

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: As the Coding Director, you will oversee the coding operations, ensuring accurate and efficient coding reviews of medical procedures and diagnoses. You will lead a team of coding professionals, providing guidance and support to maintain compliance with Medicare and Medicaid regulations. Your expertise will be crucial in optimizing coding processes and enhancing overall accuracy, contributing to the financial health of the organization. Position may be hybrid or remote depending on location. East or Central Region preferred but not required. • Lead and manage the coding department, including recruitment, training, and performance evaluation of staff (approximately overall scope 60 employees) • Ensure the accurate coding of medical procedures and diagnoses in compliance with federal and state regulations, including Medicare and Medicaid guidelines. • Develop and implement efficient coding workflows to enhance accuracy and productivity. • Collaborate closely with the SIU Medical Director to align coding practices with organizational goals. • Work in partnership with other departments, such as compliance, to ensure seamless operations and adherence to all regulatory requirements. • Conduct regular audits and reviews of coding accuracy and compliance, providing constructive feedback and training to staff as necessary. • Stay informed about changes in coding regulations and Medicare/Medicaid guidelines to maintain ongoing compliance. • Provide education and training to coding staff on new regulations, coding updates, and industry best practices. • Promptly and accurately resolve coding-related issues and discrepancies. • Prepare and present regular reports on coding performance, trends, and areas for improvement to senior management. Required Qualifications: · Minimum 8 years of healthcare experience, including 5 years of experience in medical coding · Proven experience in a leadership role, managing and mentoring a team of coding professionals preferred. · In-depth understanding of coding regulations, including ICD-10, CPT, HCPCS, and compliance requirements for Medicare and Medicaid. · Strong analytical and problem-solving abilities, with attention to detail and accuracy. · Excellent verbal and written communication skills, with the ability to convey complex information clearly and effectively. · Proficiency in coding software, electronic health records (EHR), and other relevant tools. Preferred Qualifications: · Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification · Registered Nurse (RN), Licensed Independent Social Worker (LISW), or Licensed Master Social Worker (LMSW) · Additional certifications such as Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT). · Experience with electronic health records (EHR) systems, coding software and other relevant tools. Education and Certifications. • Bachelor's degree preferred/specialized training/relevant professional qualification. Pay Range The typical pay range for this role is: $100,000.00 - $231,540.00 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. This position also includes an award target in the company’s equity award program. 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 We anticipate the application window for this opening will close on: 03/26/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job