Healthcare Coding Quality Auditor

Internationalinsuranceprofessionals; West Virginia; On-site; USD 25,000 - 54,000; Full time

Benefits offered by this job

Medical coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking a skilled Medical Records Auditor to audit and abstract provider and vendor records, ensuring accurate ICD coding for CMS submissions. The role emphasizes compliance with HIPAA, state and federal regulations and precise documentation to support risk adjustment.

The ideal candidate has CPC/CCS-P credentials and at least 1 year of related experience, with strong proficiency in MS Office and outbound communications to obtain missing records.

Qualifications

• CPC or CCS-P certification required.
• Proficient with Microsoft Office.
• Experience with ICD codes required.
• Minimum 1 year in medical record documentation review and/or auditing.
• Ability to contact providers by phone/fax for record retrieval and audits.

Responsibilities

• Audit and abstract provider and/or vendor medical records to identify CMS-reported ICD codes.
• Validate that codes support risk adjustment processes and comply with state/federal regulations and policies.
• Ensure accuracy and documentation sufficiency for medical necessity.
• Identify active vs historical conditions and support etiology/manifestations of disease.
• Adhere to timelines and perform self-audits for regulatory guidance compliance.

Skills

Medical coding

MS Office

Provider outreach

ICD coding

Auditing

Education

AA/AS or equivalent

CPC/CCS-P credential training

Tools

Coding applications

ICD coding tools

Job description

CVS Health is seeking a skilled Medical Records Auditor to audit and abstract provider and vendor records, ensuring accurate ICD coding for CMS submissions. The role emphasizes compliance with HIPAA, state and federal regulations and precise documentation to support risk adjustment.

The ideal candidate has CPC/CCS-P credentials and at least 1 year of related experience, with strong proficiency in MS Office and outbound communications to obtain missing records.