ICD Coding Quality Auditor & Risk-Adjustment Analyst

Internationalinsuranceprofessionals; Georgia; Hybrid; USD 60,460,000 - 128,914,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking a qualified Risk Adjustment Auditor to perform quality inter-rater audits of medical records and ICD-10 coding for CMS risk adjustment. The role requires experience with Medicare/Commercial/Medicaid risk adjustment and proficiency with ICD coding, CMS guidelines, and HIPAA compliance.

The successful candidate will mentor staff, communicate audit results to stakeholders, and drive process improvements while meeting tight deadlines and maintaining high accuracy in a

Qualifications

• 5+ years of experience in medical record documentation review, diagnosis coding or auditing.
• Experience with Medicare/Commercial/Medicaid risk adjustment processes and HCCs.
• CPC/CCS-P/CRC credentials or equivalent

Responsibilities

• Perform quality inter-rater review audits of medical records for ICD coding.
• Mentor staff and educate on ICD codes and documentation requirements.
• Communicate audit results to departments and management; identify improvement opportunities.

Skills

MS Office

ICD codes

Medical record auditing

Communication skills

Regulatory compliance

Education

BA/BS or equivalent experience

Job description

CVS Health is seeking a qualified Risk Adjustment Auditor to perform quality inter-rater audits of medical records and ICD-10 coding for CMS risk adjustment. The role requires experience with Medicare/Commercial/Medicaid risk adjustment and proficiency with ICD coding, CMS guidelines, and HIPAA compliance.

The successful candidate will mentor staff, communicate audit results to stakeholders, and drive process improvements while meeting tight deadlines and maintaining high accuracy in a