Healthcare Coding & Data Quality Auditor

CVS Health; United States; À distance; USD 2 549 000 - 5 348 000; Plein temps

Résumé du poste

CVS Health is seeking a Medical Records Auditor to audit and abstract provider and vendor records, ensuring accurate ICD coding for CMS submissions. You will validate risk adjustment codes, maintain HIPAA compliance, and work within strict timelines to support regulatory requirements.

Strong communication with providers and proficient MS Office use are essential. The role requires CPC/CCS-P certification, 1+ year of related experience, and familiarity with ICD coding and documentation standards

Qualifications

• Must have CPC or CCS-P certification.
• Proficient with MS Office and typical coding applications.
• Experience with outbound provider communications for data retrieval.
• Experience with ICD codes required.
• Minimum 1 year of medical record review, diagnosis coding, or auditing.

Responsabilités

• Audit and abstraction of provider and/or vendor medical records to identify ICD codes submitted to CMS.
• Validate that codes used for risk adjustment are accurate, documented, and compliant with regulations.
• Adhere to timelines and project deadlines.
• Perform self-audit to ensure compliance with policies and CMS/OIG guidance.
• Handle patient data in accordance with HIPAA Privacy and Security rules.

Connaissances

Medical coding

HIPAA compliance

Medical terminology

Documentation review

ICD coding

MS Office

Formation

AA/AS or equivalent

CPC/CCS-P credential training

Outils

Microsoft Office

Description du poste

CVS Health is seeking a Medical Records Auditor to audit and abstract provider and vendor records, ensuring accurate ICD coding for CMS submissions. You will validate risk adjustment codes, maintain HIPAA compliance, and work within strict timelines to support regulatory requirements.

Strong communication with providers and proficient MS Office use are essential. The role requires CPC/CCS-P certification, 1+ year of related experience, and familiarity with ICD coding and documentation standards