Coding Auditor, CVS Health

CVS Health

Location:
United States, Work At Home, Texas

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

21.10 - 40.90 USD / Hour

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Job Description:

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

Reviews health risk evaluations within required timelines to determine completion and compliance with CMS guidelines
Reviews and assesses the accuracy, completeness, specificity and appropriateness of diagnosis codes identified in the health risk evaluations
Reviews health risk assessments/evaluations to accurately and completely assign all ICD-10 codes that are clinically identified and supported in the assessment/evaluation on a timely basis
Communicates timely and effectively with the Director of Coding, Coding Coordinators and Group Leaders regarding issues or corrections with the health risk evaluations
Understands the relationship between ICD-10-CM coding and HCC (hierarchical condition categories) coding
Utilizes advanced, specialized knowledge of medical codes and coding protocol by collaborating with the Director of Coding and coding staff to ensure the organization is following Medicare coding protocol for payment of claims
Demonstrates a commitment to integrating coding compliance standards into coding practices
Identifies, corrects and reports coding problems
Maintains adequate knowledge of coding, compliance and reimbursement procedures related to Medicare risk adjustment
Makes recommendations for coding policy/changes
Maintains coding certification after achieving certification status
Completes special projects as assigned by the Director of Coding or designee which require defining problems and implementing required changes
Follows all legal and policy requirements for HIPAA protected data
Actively demonstrates teamwork at all times
Strong familiarity with the Coding Clinic
Is able to index conditions accurately and appropriately
Must meet and maintain productivity and accuracy targets
Expert level understanding of coding guidelines and is able to use and apply appropriate judgement

Requirements:

Minimum 4 years of coding audit experience
Minimum 6 year ICD-10 coding experience
Prior work experience in the healthcare field specifically related to coding is preferred
Experience and knowledge of Medicare HCC coding
Experience with medical record documentation
Prior medical chart auditing/quality experience required
Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology
Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Coding Specialist for providers (CCS-P) or Certified Professional Coder (CPC)
CRC required
ICD-10 Coding Certification
Credentials of at least 6 years by AHIMA or AAPC required
Current coding certificate in a good standing
Knowledge of CMS RADV protocols
High school diploma or equivalent
Associate's or Bachelor Degree preferred
Basic skills in MS Office
Basic analytical skills

Nice to have:

Associate's or Bachelor Degree preferred
Basic skills in MS Office
Basic analytical skills

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including 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:
April 23, 2025

Expiration:
July 17, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Coding Auditor