Healthcare Coding Quality Auditor

CVS Health; Beryl (WV); On-site; USD 25,000 - 49,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Job summary

CVS Health is seeking a licensed professional to perform audit and abstraction of medical records to identify and submit ICD codes for CMS risk adjustment. You will support coding judgments and ensure accuracy and documentation meets state and federal regulations.

In this role you will review records for etiology and manifestations, adhere to timelines, and conduct self-audits to maintain compliance. A CPC/CCS-P credential and 1 year of related experience are preferred, with a strong foundation

Qualifications

• Requires CPC or CCS-P certification.
• 1 year of related experience in medical record documentation review, diagnosis coding, and/or auditing.
• Proficient with ICD codes and documentation review.
• Experience with MS Office and industry coding applications.

Responsibilities

• Audit and abstraction of medical records to identify and submit ICD codes for CMS risk adjustment.
• Support coding judgments using industry-standard evidence and tools.
• Assign accurate medical codes as documented by clinicians.
• Ensure codes meet regulatory guidelines and medical necessity.
• Identify active vs historical conditions based on documentation.
• Utilize records to support etiology and manifestations of disease.
• Adhere to deadlines and project timelines.
• Perform self-audit checks for compliance with policies and CMS/OIG guidance.

Skills

Medical record auditing

ICD coding

Regulatory compliance

CMS guidelines

Documentation review

Education

AA/AS or equivalent experience

AAPC/AHIMA CPC/CCS-P training program

Tools

Microsoft Office

Job description

CVS Health is seeking a licensed professional to perform audit and abstraction of medical records to identify and submit ICD codes for CMS risk adjustment. You will support coding judgments and ensure accuracy and documentation meets state and federal regulations.

In this role you will review records for etiology and manifestations, adhere to timelines, and conduct self-audits to maintain compliance. A CPC/CCS-P credential and 1 year of related experience are preferred, with a strong foundation