ICD Coding Data Quality Auditor

4062 Aetna Resources, LLC; United States; On-site; USD 29,000 - 51,000; Full time

Job summary

CVS Health is seeking a Coding Data Quality Audit Analyst to perform second-level quality inter-rater review audits of medical records coded by internal teams and external vendors, ensuring ICD codes submitted to CMS are accurate and supported by clinical documentation in accordance with regulations and internal policies.

This role requires clear communication of audit evidence to stakeholders, mentorship of staff on ICD coding, and proactive process audits to maintain compliance and drive

Qualifications

• Minimum 3 years of related experience in medical record documentation review, diagnosis coding, and/or auditing.
• Associate degree or equivalent experience.
• CPC or CCS-P certification required.
• CRC certification within the first six months (preferred).

Responsibilities

• Demonstrates the ability to support coding judgments and decisions using industry-standard evidence and tools.
• Confidently communicates supporting evidence to internal stakeholders with varying levels of coding and clinical expertise through both written and verbal communication.
• Acts as a mentor by providing education to internal staff based on audit findings and offers general education on ICD coding.
• Conducts process audits to ensure compliance with internal policies, procedures, CMS regulations, and guidance from the OIG and other regulatory bodies.
• Demonstrates the ability to work independently and collaboratively across cross-functional teams to promote best practices.
• Adheres to stringent timelines and project deadlines.

Education

AA/AS or equivalent

CPC/CCS-P certification

CRC within 6 months (preferred)

Job description

CVS Health is seeking a Coding Data Quality Audit Analyst to perform second-level quality inter-rater review audits of medical records coded by internal teams and external vendors, ensuring ICD codes submitted to CMS are accurate and supported by clinical documentation in accordance with regulations and internal policies.

This role requires clear communication of audit evidence to stakeholders, mentorship of staff on ICD coding, and proactive process audits to maintain compliance and drive