Healthcare Coding & Data Quality Auditor

CVS Health; Wilmington (VT); On-site; USD 25,000 - 49,000; Full time

Job summary

CVS Health in the United States is seeking a skilled medical record auditor and coder to perform abstraction of records and identify ICD codes for CMS risk adjustment. You will apply coding guidelines, ensure medical necessity, and work to meet deadlines while upholding regulatory standards.

This full-time role offers comprehensive benefits and opportunities to contribute to patient-centered care across our health ecosystem.

Qualifications

• Minimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
• CPC/ CCS-P required.
• Computer proficiency including experience with Microsoft Office products.

Responsibilities

• Proven ability to support coding judgment and decisions using industry standard evidence and tools.
• Proficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other qualified healthcare providers in the office and/or facility setting.
• Sound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity.
• Identify clinically active vs historical conditions
• Diagnosis codes must be appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.
• 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.
• Conducts self- process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body.

Skills

Medical coding

Auditing

ICD coding

Education

AA/AS or equivalent

CPC/CCS-P credential training (AAPC/AHIMA)

Tools

Microsoft Office

Job description

CVS Health in the United States is seeking a skilled medical record auditor and coder to perform abstraction of records and identify ICD codes for CMS risk adjustment. You will apply coding guidelines, ensure medical necessity, and work to meet deadlines while upholding regulatory standards.

This full-time role offers comprehensive benefits and opportunities to contribute to patient-centered care across our health ecosystem.