Note: The job is a remote job and is open to candidates in USA. CVS Health is hiring a Coding Data Quality Audit Analyst to conduct second-level audits of medical records coded for risk adjustment. The role verifies that ICD codes submitted to CMS are accurate, supported by clinical documentation, and compliant with regulations and internal policies.
Responsibilities
- Demonstrates the ability to support coding judgments and decisions using industry-standard evidence and tools
- Confidently communicates supporting evidence to internal stakeholders with varying levels of coding and clinical expertise through both written and verbal communication, including interactions with clinical staff, coding staff, federal regulators, and vendor coding resources
- Acts as a mentor by providing education to internal staff based on audit findings and offers general education on ICD coding, as appropriate
- Conducts process audits to ensure compliance with internal policies, procedures, CMS regulations, and guidance from the Office of Inspector General (OIG) and other regulatory bodies
- Demonstrates the ability to work independently and collaboratively across cross-functional teams to promote best practices
- Adheres to stringent timelines and project deadlines
- Demonstrates a genuine commitment to quality improvement, accuracy, and thoroughness while assisting others in achieving the same through mentorship and instruction
- Maintains thorough knowledge of coding guidelines and regulations to ensure compliance requirements are met, including the establishment of medical necessity
- Identifies and communicates documentation deficiencies to support ongoing education and development opportunities for peers
- Maintains extensive knowledge of medical documentation requirements, fraud and abuse regulations, and penalties associated with documentation and coding violations based on governmental guidelines
Skills
- CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) certification required
- Minimum of 3 years of recent, related experience in medical record documentation review, diagnosis coding, and/or auditing
- Completion of an AAPC or AHIMA training program for a core credential (CPC or CCS-P), with associated work history and on-the-job experience equivalent to approximately 3 years for CPC certification
- Associate degree, or equivalent experience
- CRC (Certified Risk Adjustment Coder) required within the first six months
- Preferred
Benefits
- This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
- This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
- Medical, dental, and vision coverage, based on eligibility.
- Paid time off, based on eligibility.
- Retirement savings options, based on eligibility.
- Wellness programs, based on eligibility.
- Other resources, based on eligibility.
- Work at Home
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