ICD Coding Quality Auditor – Risk Adjustment Expert

Internationalinsuranceprofessionals; New York, Northern (NY, KY); Hybrid; USD 29,000 - 62,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a detail‑oriented reviewer to perform quality audits of medical records coded for CMS risk adjustment. You will support ICD coding accuracy, mentor staff, and lead dispute resolution across teams to ensure regulatory compliance.

The role emphasizes independent work and cross‑functional collaboration with policy and clinical staff, focusing on improving documentation quality and audit outcomes within a full‑time schedule.

Qualifications

• Proficient with Microsoft Office (Word, Excel, Outlook, PowerPoint) and industry coding tools.
• Experience with ICD codes and risk adjustment processes.
• Minimum 5 years in medical record documentation review, coding, and/or auditing.

Responsibilities

• Perform quality inter-rater review audits of medical records coded by internal teams.
• Lead dispute resolution and mentor staff based on audit findings.
• Communicate audit processes and results to departments and management; ensure CMS regulatory compliance.
• Identify opportunities for process improvement to meet productivity and quality goals.
• Maintain adherence to HIPAA and state/federal privacy regulations.

Skills

Microsoft Office

ICD codes

Medical record auditing

Risk adjustment

CPC/CCS-P/CRC

Education

BA/BS or equivalent

AAPC/AHIMA CPC/CCS-P training

Job description

CVS Health is seeking a detail‑oriented reviewer to perform quality audits of medical records coded for CMS risk adjustment. You will support ICD coding accuracy, mentor staff, and lead dispute resolution across teams to ensure regulatory compliance.

The role emphasizes independent work and cross‑functional collaboration with policy and clinical staff, focusing on improving documentation quality and audit outcomes within a full‑time schedule.