Health Data Quality Auditor — ICD/Risk Adjustment

Internationalinsuranceprofessionals; New York (NY); On-site; USD 53,010,000 - 111,236,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Job summary

CVS Health is seeking a skilled Medical Coder/Auditor to audit and abstract provider and vendor medical records for CMS ICD codes and risk adjustment accuracy. You will ensure codes are supported by documentation, compliant with state and federal regulations, and processed within tight deadlines.

The role requires CPC/CCS-P or equivalent certification, proficiency in ICD coding, and experience with medical record review. Strong attention to detail and adherence to HIPAA are essential.

Qualifications

• CPC or CCS-P certification required.
• Experience with ICD coding and medical record review.
• Proficient with Microsoft Office and coding applications.
• Minimum 1 year experience in medical record documentation review or auditing.

Responsibilities

• Audit and abstract provider/vendor medical records to identify CMS ICD codes.
• Validate risk adjustment codes are accurate and compliant with regulations.
• Ensure documentation supports etiology and disease manifestations.
• Maintain timelines and conduct self-audits to ensure compliance.
• Follow HIPAA Privacy and Security rules in handling patient data.

Skills

Medical coding

Auditing

HIPAA compliance

ICD coding

Communication

Education

AA/AS or equivalent experience

AAPC/AHIMA CPC/CCS-P training

Tools

Microsoft Office

Coding applications

Job description

CVS Health is seeking a skilled Medical Coder/Auditor to audit and abstract provider and vendor medical records for CMS ICD codes and risk adjustment accuracy. You will ensure codes are supported by documentation, compliant with state and federal regulations, and processed within tight deadlines.

The role requires CPC/CCS-P or equivalent certification, proficiency in ICD coding, and experience with medical record review. Strong attention to detail and adherence to HIPAA are essential.