Coding Data Quality Auditor, CVS Health

CVS Health

Location:
United States

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

18.50 - 42.35 USD / Hour

Save Job

Apply Position

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:

Performing quality inter-rater review audits of medical records coded by internal team
Ensuring ICD-10 codes submitted to CMS for risk adjustment processes are appropriate, accurate, and supported by clinical documentation
Supporting coding judgment and decisions using industry standard evidence and tools
Leading dispute resolution
Acting as mentor to provide education to internal staff based on audit findings
Effectively communicating audit process and results to appropriate departments and management
Conducting process audits to ensure compliance with internal policies and procedures and CMS regulations
Identifying and recommending opportunities for process improvements
Serving as training resource and subject matter expert for vendors, providers and other team members for ICD coding and documentation questions

Requirements:

CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician)
CRC (Certified Risk Adjustment Coder) must be able to obtain within 1 year of employment
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 2 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing

Nice to have:

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 CRC (HCC)
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 26, 2025

Expiration:
November 03, 2025

Employment Type:

Fulltime

Work Type:

Remote work

View All Jobs In This Company

Job Link Share:

Coding Data Quality Auditor