Healthcare Data Quality & Coding Auditor

CVS Health; Columbia (SC); On-site; USD 26,000 - 48,000; Full time

Job summary

CVS Health is seeking an audit and abstraction specialist to review medical records and assign ICD codes for CMS risk adjustment. This full-time role focuses on accuracy, compliance, and timely delivery in both provider and vendor settings.

You will verify documentation, adhere to coding guidelines, and support risk adjustment processes with precise data. A CPC/CCS-P credential and ICD proficiency are required.

Qualifications

• Minimum of 1 year recent experience in medical record documentation review, diagnosis coding, and/or auditing.
• CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required.
• Computer proficiency including Microsoft Office (Word, Excel, Access, PowerPoint, Outlook) and coding applications.
• Experience with International Classification of Diseases (ICD) codes required.

Responsibilities

• Audit and abstract medical records to identify and submit ICD codes for CMS risk adjustment.
• Support coding judgments using industry-standard evidence and tools.
• Ensure codes are accurate, supported by documentation, and compliant with regulations.
• Identify clinically active vs historical conditions and verify etiology/manifestions.
• Adhere to deadlines and perform self-audits to ensure policy compliance.

Skills

Microsoft Office

ICD coding

Education

AA/AS or equivalent

AAPC/AHIMA CPC/CCS-P credential training

Job description

CVS Health is seeking an audit and abstraction specialist to review medical records and assign ICD codes for CMS risk adjustment. This full-time role focuses on accuracy, compliance, and timely delivery in both provider and vendor settings.

You will verify documentation, adhere to coding guidelines, and support risk adjustment processes with precise data. A CPC/CCS-P credential and ICD proficiency are required.