At CVS Health, we are building a world of health around every consumer with dedicated colleagues transforming health care. We are looking for a Coding Data Quality Auditor to join our mission. In this role, you will be responsible for performing audit and abstraction of medical records to identify and submit ICD codes to CMS for risk adjustment processes, ensuring they are appropriate, accurate, and supported by clinical documentation.
What You'll Do
- Perform audit and abstraction of medical records from providers and vendors.
- Identify and submit ICD codes to CMS for risk adjustment processes.
- Support coding judgment and decisions using industry standard evidence and tools.
- Abstract and assign accurate medical codes for diagnoses as documented by healthcare providers.
- Apply knowledge of coding guidelines and regulations to meet compliance requirements.
- Identify clinically active versus historical conditions.
- Ensure diagnosis codes are appropriate, accurate, and supported by clinical documentation.
- Utilize medical records to ensure support is documented for etiology and manifestations of disease processes.
- Adhere to stringent timelines consistent with project deadlines and directives.
- Conduct self-process audits to ensure compliance with internal policies and regulatory guidance.
What We're Looking For
- A minimum of 1 year of recent, related experience in medical record documentation review, diagnosis coding, and/or auditing.
- CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) certification is required.
Nice to Have
- An AA/AS degree or equivalent experience.
- Completion of an AAPC or AHIMA training program for core credential (CPC, CCS-P) with associated work history or on-the-job experience equal to approximately 1-2 years for CPC.
Benefits & Compensation
- Compensation: $18.50 - $42.35 per hour.
- Affordable medical plan options.
- 401(k) plan with matching company contributions.
- Employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation, weight management, confidential counseling, and financial coaching.
- Benefit solutions including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, and retiree medical access.
CVS Health is an equal opportunity employer. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
