Coding Data Quality Auditor Job at CVS Health

Deputy Director - Quality (Medical Coding)

We are seeking an experienced Medical Coding leader to join our team in Chennai ...

Location

India , Chennai

Salary:

Not provided

Access Healthcare LLC

Expiration Date

Until further notice

Requirements

Deep understanding of medical coding standards and audit processes
Experience with automation and AI solutions in coding audits
Proficiency in developing and managing quality metrics dashboards
Strategic leadership and ability to influence cross-functional teams
Strong problem-solving and decision-making capabilities
Excellent communication and stakeholder management skills
Minimum 13 years of experience in Healthcare Revenue Cycle Management (RCM) and Quality Assurance
At least 5 to 6 years of core multispecialty coding expertise
Certified Six Sigma Black Belt/Master Black Belt from recognized institutions (e.g., ISI, ASQ, Benchmark, KPMG) with proven project experience
Expertise in coding audit frameworks, accuracy improvement strategies, and regulatory compliance

Job Responsibility

Oversee comprehensive quality audits for coding across in-house teams and multiple vendors
Enforce coding best practices to mitigate risks such as missed diagnoses, over-coding, or under-coding
Drive external and internal audit programs aimed at improving compliance and accuracy
Design and elevate quality control frameworks to ensure coding accuracy and operational efficiency
Lead initiatives to reduce error rates, enhance coding precision, and boost productivity
Implement cutting-edge, AI-enabled audit solutions such as automated coding reviews and real-time QA tools
Monitor and report on Accuracy KPIs, including Missed Error Rate, Extra Error Rate, and Inter-Rater Reliability
Utilize robust data analytics to assess trends in coding accuracy and identify compliance risks
Develop executive dashboards and reports to provide insights into quality performance metrics
Partner with Operations and Training teams to address and resolve coding discrepancies while implementing corrective action plans

New

Coding Data Quality Auditor, Analyst

Responsible for performing quality inter-rater review audits of medical records ...

Location

United States

Salary:

21.10 - 44.99 USD / Hour

CVS Health

Expiration Date

March 27, 2026

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

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

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

Fulltime

New

Analyst, Coding Data Quality Auditor

We’re building a world of health around every individual — shaping a more connec...

Location

United States

Salary:

21.10 - 44.99 USD / Hour

CVS Health

Expiration Date

March 13, 2026

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
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
Bachelor of Arts/ Bachelor of Science Degree 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

Job Responsibility

Responsible for performing quality inter-rater review audits of medical records coded by internal team (CDQA and Sr CDQA) 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
Proven ability to support coding judgment and decisions using industry standard evidence and tools
Ability to confidently speak to such evidence across stakeholders with varying knowledge and clinical expertise in either written or verbal forms including communication with clinical or coding staff, federal regulators and vendor coding resources
Conducts process audits to ensure compliance with internal policies and procedures and existing CMS regulations
Ability to work independently as well as in a cross functional role within other teams for collaboration on best practices
Possesses a genuine interest in improving and promoting quality
demonstrates accuracy and thoroughness and assists others to achieve the same through mentoring and instruction
Conducts process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body
Expertise in assigning accurate medical codes for diagnoses as documented for physicians and other qualified healthcare providers in the office and/or facility setting
Thorough knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity

What we offer

Affordable medical plan options
a 401(k) plan (including matching company contributions)
an employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility

Fulltime

New