Healthcare Coding Quality Auditor - Risk Adjustment

Internationalinsuranceprofessionals; Georgia; On-site; USD 53,010,000 - 111,236,000; Full time

Job summary

CVS Health is seeking a Medicare/medical records auditor to validate ICD coding for risk adjustment. The role requires strong auditing skills, attention to regulatory detail, and effective communication with providers for record retrieval.

Responsibilities include coding accuracy, documentation validation, and adherence to CMS, OIG, and HIPAA standards while meeting timelines. This is a full-time, on-site position in Georgia with a comprehensive benefits package.

Qualifications

• Experience in medical record documentation review and coding auditing.
• Knowledge of ICD coding guidelines and CMS/HIPAA regulations.
• Proficient with Microsoft Office and coding applications.
• Ability to communicate with providers for record retrieval.

Responsibilities

• Audit and abstract provider/ vendor records to identify CMS ICD codes.
• Validate accuracy of risk adjustment codes and documentation.
• Ensure compliance with state/federal regulations and internal policies.
• Perform self-audits and meet project deadlines.
• Maintain ethical handling of patient data under HIPAA.

Skills

Medical coding

Record review

HIPAA compliance

MS Office

Education

AA/AS or equivalent experience

AAPC/AHIMA credential training CPC/CCS-P

Tools

Coding software

Job description

CVS Health is seeking a Medicare/medical records auditor to validate ICD coding for risk adjustment. The role requires strong auditing skills, attention to regulatory detail, and effective communication with providers for record retrieval.

Responsibilities include coding accuracy, documentation validation, and adherence to CMS, OIG, and HIPAA standards while meeting timelines. This is a full-time, on-site position in Georgia with a comprehensive benefits package.