Healthcare Data Quality & Coding Auditor

Internationalinsuranceprofessionals; Ohio; On-site; USD 38,000 - 81,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Job summary

CVS Health is seeking a Medical Records Auditor to review provider and vendor records for CMS ICD code submission and risk adjustment accuracy. You will validate documentation, ensure compliance with state and federal regulations, and maintain timely audits with ethical handling of patient data under HIPAA rules.

Responsibilities include retrieving records via calls and faxes, applying ICD coding, and ensuring documentation supports disease etiology and manifestations.

Qualifications

• AA/AS or equivalent experience required for entry.
• Completion of AAPC/AHIMA training program for CPC/CCS-P with work history.

Responsibilities

• Audit and abstraction of medical records to identify CMS ICD codes.
• Validate codes for risk adjustment accuracy and compliance.
• Ensure codes are supported by clinical documentation and regulations.
• Perform self-audit to ensure policy and CMS guidance adherence.
• Communicate with providers to obtain records and clarify audits.

Skills

Medical coding

ICD coding

Communication

HIPAA compliance

Education

AA/AS or equivalent

AAPC/AHIMA CPC/CCS-P training

Tools

Microsoft Office

Coding applications

Job description

CVS Health is seeking a Medical Records Auditor to review provider and vendor records for CMS ICD code submission and risk adjustment accuracy. You will validate documentation, ensure compliance with state and federal regulations, and maintain timely audits with ethical handling of patient data under HIPAA rules.

Responsibilities include retrieving records via calls and faxes, applying ICD coding, and ensuring documentation supports disease etiology and manifestations.