We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
The Provider Flag Management Senior Coding Analyst is responsible for supporting the monitoring and ongoing management of provider flags across Commercial, Medicare, and Medicaid lines of business. This role partners with SIU Investigations, Coding, Prevention, Medical Directors, and operational teams to evaluate flag requests, analyze claim and inventory impacts, maintain governance processes, and support provider flag performance monitoring.
Additionally, the Flag Management Analyst collaborates with business partners to resolve complex flag-related issues, supports implementation of new flag strategies and enhancements, and contributes to continuous improvement initiatives that strengthen provider oversight and claim review operations. Responsibilities align with the organization's Flag Governance framework and provider flag management processes while promoting collaboration, accountability, and operational excellence.
Key Responsibilities:
- Review and analyze provider flag requests, including claim volume, financial impact, and inventory implications.
- Partner with investigation, coding, and CCR teams to construct recommendations and present findings to leadership and governance committees.
- Collaborate with SIU Investigators, Coding, Prevention, CCR, and Medical Directors via flag governance facilitation
- Monitor existing CCR, coding and administratively denied flags and evaluate performance metrics to support continuation, modification, or removal recommendations.
- Identify opportunities for mitigation strategies and operational improvements when flag placement is not approved or requires modification.
Required Qualifications and Skills:
- 3+ years of experience in Behavioral Health and Medical Coding.
- Knowledge of Commercial, Medicare, and Medicaid claims processing and payment methodologies.
- Experience analyzing healthcare claims data and utilizing reporting tools to identify trends, risks, or operational opportunities.
- Demonstrated experience managing multiple priorities, projects, or workflows in a fast-paced environment.
- Experience with Microsoft Excel, reporting tools, and healthcare data analysis.
- Experience collaborating across multiple departments to drive processes, resolve issues, and achieve business objectives.
- Must be able to travel to provide testimony if needed.
Preferred Qualifications:
- Experience supporting provider flag management, provider review programs, claims editing, payment integrity, SIU, or fraud/waste/abuse initiatives.
- Experience working with provider data, NPI/TIN structures, claim inventory management, or case management systems.
- Familiarity with healthcare coding principles, medical record review processes, or claim adjudication workflows.
- Knowledge of healthcare regulations, compliance standards, and fraud prevention strategies.
- Experience facilitating governance reviews, stakeholder meetings, and presenting recommendations to senior leadership.
- Strong analytical, critical thinking, and problem-solving skills with the ability to make data-driven recommendations.
- Excellent written and verbal communication skills with experience presenting findings to business partners and leadership.
- Experience working in Microsoft PowerPoint.
Education
- AAPC Certified Professional Coder Certification (CPC).
- GED or High School diploma.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$46,988.00 - $112,200.00This 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 3+ years of experience in behavioral health and medical coding
- Knowledge of Commercial, Medicare, and Medicaid claims processing and payment methodologies
- Experience analyzing healthcare claims data and using reporting tools to identify trends, risks, or operational opportunities
- Experience managing multiple priorities, projects, or workflows in a fast-paced environment
- Experience with Microsoft Excel, reporting tools, and healthcare data analysis
- Experience collaborating across multiple departments to drive processes, resolve issues, and achieve business objectives
- Ability to travel to provide testimony if needed
- Experience supporting provider flag management, provider review programs, claims editing, payment integrity, SIU, or fraud, waste, and abuse initiatives
- Experience with provider data, NPI/TIN structures, claim inventory management, or case management systems
- Familiarity with healthcare coding principles, medical record review processes, or claim adjudication workflows
- Knowledge of healthcare regulations, compliance standards, and fraud prevention strategies
- Experience facilitating governance reviews, stakeholder meetings, and presenting recommendations to senior leadership
- Strong analytical, critical thinking, and problem-solving skills with the ability to make data-driven recommendations
- Excellent written and verbal communication skills with experience presenting findings to business partners and leadership
- Experience working in Microsoft PowerPoint
- AAPC Certified Professional Coder certification (CPC)
- GED or high school diploma
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
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Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
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Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
