Coding QA & Compliance Manager: AI-Driven Audits

CVS Health Corporation; Chicago, Northern (IL, KY); Hybrid; USD 66,000 - 146,000; Full time

Benefits offered by this job

Health insurance

401K match

Paid time off

Education stipends

Job summary

Oak Street Health, part of CVS Health, seeks an experienced Manager of Coding Quality and Compliance to lead auditing, AI-enabled coding workflows, and Epic rule design. You will guide cross-functional teams in Rev Cycle, Coding, and Clinical Documentation while ensuring CMS and AHIMA standards.

The role emphasizes leadership, risk adjustment expertise, and the ability to translate complex compliance concepts for stakeholders across the organization.

Qualifications

• Certified coding credentials required (CCS/CCA/CPC).
• Experience with risk-adjusted coding and auditing medical charts.
• Experience designing AI-enabled coding workflows.
• Proven leadership and cross-functional collaboration in health tech.

Responsibilities

• Internal Auditing Controls: daily quality checks and secondary reviews for coding accuracy.
• RADV readiness: manage external audits and mock RADV reviews.
• Query Compliance Oversight: enforce AHIMA/ACDIS standards for compliant documentation.
• Epic Rule Engine Optimization: translate risk parameters to Epic tools.
• Deletion Log Maintenance: enforce 60-day overpayment refund processes.
• Payer Data Ingestion Auditing: verify CMS coding standards before risk submissions.

Skills

Coding quality

Auditing

AI workflows

Leadership

CMS RADV

Education

CCS/CCA/CPC certification

AHIMA/AAPC credential

Tools

Epic

Job description

Oak Street Health, part of CVS Health, seeks an experienced Manager of Coding Quality and Compliance to lead auditing, AI-enabled coding workflows, and Epic rule design. You will guide cross-functional teams in Rev Cycle, Coding, and Clinical Documentation while ensuring CMS and AHIMA standards.

The role emphasizes leadership, risk adjustment expertise, and the ability to translate complex compliance concepts for stakeholders across the organization.