Analyst, Coding Data Quality Auditor, CVS Health

CVS Health

Location:
United States

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

21.10 - 44.99 USD / Hour

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Job Description:

Responsible for performing quality inter-rater review audits of medical records coded by internal team to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.

Job Responsibility:

Perform quality inter-rater review audits of medical records coded by internal team
Ensure ICD-10 codes submitted to CMS for risk adjustment processes are appropriate, accurate, and supported by clinical documentation
Support coding judgment and decisions using industry standard evidence and tools
Communicate audit evidence across stakeholders with varying knowledge and clinical expertise
Lead dispute resolution
Act as mentor to provide education to internal staff based on audit findings
Conduct process audits to ensure compliance with internal policies and procedures and CMS regulations
Identify and recommend opportunities for process improvements
Serve as training resource and subject matter expert for vendors, providers and other team members regarding ICD coding and documentation requirements

Requirements:

Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications)
Experience with International Classification of Disease (ICD) codes required
Minimum of 5 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing
Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required
CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment Coder) required
BA/BS or equivalent experience
Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on the job experience equal to approximately 3 years for CPC
5-8 years encompassing additional credentials and/or application of credentials

Nice to have:

CPMA (Certified Professional Medical Auditor), CDEO (Certified Documentation Expert Outpatient) or CPC-I (Certified Professional Coding Instructor) preferred
Excellent analytical and problem solving skills
Superior communication, organizational, and interpersonal skills

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
October 12, 2025

Expiration:
October 27, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Analyst, Coding Data Quality Auditor