Healthcare Data Quality Auditor—Medical Coding

Internationalinsuranceprofessionals; Maine; On-site; USD 25,000 - 52,000; Full time

Benefits offered by this job

Medical coverage

Dental & vision

Retirement options

Paid time off

Job summary

CVS Health is seeking an audit-focused medical coder to validate ICD codes for CMS risk adjustment, ensuring accuracy and proper documentation in line with state and federal regulations. This role involves auditing provider and vendor records and supporting coding judgments with industry-standard evidence.

The position requires CPC/CCS-P certification, ICD coding experience, and proficiency with Microsoft Office. High attention to detail and timely communication with providers are essential.

Qualifications

• CPC or CCS-P certification required or equivalent.
• Experience with ICD coding and medical record review.
• Knowledge of HIPAA rules and coding guidelines.

Responsibilities

• Audit and abstract provider/vendor medical records for CMS risk adjustment.
• Validate codes for accuracy and documentation compliance.
• Maintain timelines and communicate with providers regarding audits.

Skills

Medical coding

Auditing

HIPAA compliance

ICD coding

Education

AA/AS or equivalent

AAPC/AHIMA training

Tools

Microsoft Office

Job description

CVS Health is seeking an audit-focused medical coder to validate ICD codes for CMS risk adjustment, ensuring accuracy and proper documentation in line with state and federal regulations. This role involves auditing provider and vendor records and supporting coding judgments with industry-standard evidence.

The position requires CPC/CCS-P certification, ICD coding experience, and proficiency with Microsoft Office. High attention to detail and timely communication with providers are essential.