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Coding Data Quality Auditor, Analyst

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States

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Contract Type:
Not provided

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Salary:

21.10 - 44.99 USD / Hour

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 are appropriate, accurate, and supported
  • Support coding judgment using industry standard evidence and tools
  • Communicate evidence across stakeholders
  • Lead dispute resolution
  • Mentor and provide education to internal staff based on audit findings
  • Communicate audit process and results to appropriate departments and management
  • Conduct process audits to ensure compliance
  • Identify and recommend opportunities for process improvements
  • Work independently and in cross functional teams
  • Adhere to stringent timelines
  • Meet coding accuracy and production standards
  • Monitor own work to help ensure quality
  • Act in ethical manner as required under HIPAA
  • Serve as training resource and subject matter expert for ICD coding and documentation
  • Apply AHA Coding Clinic guidance
  • Remain current on educational training and requirements
  • Perform other related duties as required

Requirements:

  • CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment Coder) required
  • Experience with International Classification of Disease (ICD) codes required
  • Minimum of 3 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
  • Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications)
  • 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
  • No-cost tobacco cessation programs
  • No-cost weight management programs
  • Confidential counseling
  • 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:
March 04, 2026

Expiration:
March 27, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Job Link Share:

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