Manager, Coding Quality and Compliance Auditing

CVS Health Corporation; Chicago, Northern (IL, KY); Hybrid; USD 66,000 - 146,000; Full time

Benefits offered by this job

Health insurance

401K match

Paid time off

Education stipends

Job summary

Oak Street Health, part of CVS Health, seeks an experienced Manager of Coding Quality and Compliance to lead auditing, AI-enabled coding workflows, and Epic rule design. You will guide cross-functional teams in Rev Cycle, Coding, and Clinical Documentation while ensuring CMS and AHIMA standards.

The role emphasizes leadership, risk adjustment expertise, and the ability to translate complex compliance concepts for stakeholders across the organization.

Qualifications

• Certified coding credentials required (CCS/CCA/CPC).
• Experience with risk-adjusted coding and auditing medical charts.
• Experience designing AI-enabled coding workflows.
• Proven leadership and cross-functional collaboration in health tech.

Responsibilities

• Internal Auditing Controls: daily quality checks and secondary reviews for coding accuracy.
• RADV readiness: manage external audits and mock RADV reviews.
• Query Compliance Oversight: enforce AHIMA/ACDIS standards for compliant documentation.
• Epic Rule Engine Optimization: translate risk parameters to Epic tools.
• Deletion Log Maintenance: enforce 60-day overpayment refund processes.
• Payer Data Ingestion Auditing: verify CMS coding standards before risk submissions.

Skills

Coding quality

Auditing

AI workflows

Leadership

CMS RADV

Education

CCS/CCA/CPC certification

AHIMA/AAPC credential

Tools

Epic

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Role Description

Oak Street Health®, a part of CVS Health, helps older adults stay healthier and live fuller lives through our 230 centers across 27 states. Our value-based care model helps us consistently deliver better patient experiences and outcomes.

Job Overview

Oak Street Health seeks an experienced Manager of Coding Quality and Compliance. This role requires deep medical coding expertise, experience contributing to Epic workflow design, and confidence working across teams (Rev Cycle, Coding, Clinical Documentation, executive leadership). You are a people manager, subject matter expert, problem solver, and relationship builder with a talent for creative problem solving & execution. An early adapter of Artificial Intelligence in coding who can design AI-enabled workflows. Excellent at communicating audit & compliance concepts to colleagues in other functions.

You will focus on

Team management, Technical chart auditing, Building and scaling coding processes post Epic implementation. Epic workqueue rules maintenance, deletion log tracking, external CMS RADV/OIG audit operational preparation, and AHIMA query governance.

Specific examples of workstreams include:

• Internal Auditing Controls: Conducts daily quality checks and secondary reviews among coding audit staff to verify standard industry coding guide compliance (ICD-10-CM, CPT, HCPCS), E/M code selection accuracy, and compliant Modifier usage (e.g., Modifier 25).
• VBC & RADV Audit Operations: Manages external audit execution and internal CMS Risk Adjustment Data Validation (RADV) readiness, conducting routine mock RADV audits to validate HCC chronic condition support.
• Query Compliance Oversight: Audits and enforces compliant Provider Query practices across coding and CDA staff, ensuring adherence to AHIMA/ACDIS standards to eliminate leading queries and maintain non-biased documentation integrity.
• Epic Rule Engine Optimization: Partners directly with IT analysts to translate high-risk OIG selection parameters (e.g., active stroke without hospital stay, or vascular codes without anticoagulants) and other Compliance priorities into native Epic tools.
• Deletion Log Maintenance & Overpayment Tracking: Mandates and tracks the technical Deletion & Reconciliation workflow, enforcing strict adherence to the 60-day federal overpayment refund standard.
• Payer Data Ingestion Auditing: Audits incoming payer supplemental data files, gap-closure feeds, and automated clinical inference outputs to verify that suggested chronic conditions meet CMS coding standards before inclusion in risk-score submissions.

Required Qualifications

Post secondary /high school education or specialized training, i.e., technical/vocational programs 5 to 7 years relevant experience 2 to 4 years of risk adjusted coding experience Certified Coding Specialist (CCS), Certified Coding Associate (CCA) or Certified Professional Coder (CPC) Credential of at least 3 years by AHIMA or AAPC required. Dual AAPC certification a plus. Credential must be current, in good standing, and maintained during employment. ICD-10 Coding certification ICD-9-CM coding experience ICD-10-CM coding experience Proven coding competency Prior medical chart auditing/quality experience Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes and pharmacology Experience working with and designing AI coding workflows Coding team management experience

Preferred Qualifications

• CRC
• RHIT or RHIA

Oak Street Health Benefits

Mission-focused career impacting change and measurably improving health outcomes for medicare patients

• Paid vacation, sick time, and investment/retirement 401K match options
• Health insurance, vision, and dental benefits
• Opportunities for leadership development and continuing education stipends
• New centers and flexible work environments
• Opportunities for high levels of responsibility and rapid advancement

Oak Street Health is an equal opportunity employer.

We embrace diversity and encourage all interested readers to apply.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $66,330.00 - $145,860.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 11/30/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.