Manager, Coding Quality and Compliance Auditing

CVS Health; Illinois; Hybrid; USD 66,000 - 146,000; Full time

Benefits offered by this job

Paid time off

401K match

Health insurance

Job summary

Oak Street Health, part of CVS Health, seeks an experienced Manager of Coding Quality and Compliance to lead chart auditing, Epic rule engine optimization, and external CMS RADV readiness. You will collaborate with Rev Cycle, Coding, Clinical Documentation, and leadership to ensure accurate coding and compliant documentation.

The role emphasizes maternal risk adjustment workflows, deletion/log reconciliation, and payer data auditing to maintain CMS standards and protect program integrity.

Qualifications

• 5 to 7 years relevant experience required.
• Credential of AHIMA or AAPC required; dual certification a plus.
• ICD-10-CM coding certification required; ICD-9-CM experience beneficial.

Responsibilities

• Conducts daily quality checks and secondary reviews to verify coding guide compliance (ICD-10-CM, CPT, HCPCS).
• Manages external CMS RADV audits and internal readiness, including mock RADV audits.
• Audits and enforces AHIMA/ACDIS-compliant query practices across coding staff.
• Translates high-risk OIG parameters into native Epic tools with IT teams.
• Tracks deletion log processes and ensures 60-day overpayment refund adherence.
• Audits payer data to validate CMS coding standards before risk-score submission.

Skills

Risk-adjusted coding

Audit/quality experience

Epic workflow understanding

Communication of audits

Deletion log tracking

Education

CCS

CCA

CPC

AHIMA or AAPC credential

ICD-10-CM certification

ICD-9-CM experience

ICD-10-CM experience

Tools

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 subject matter expert, problem solver, and relationship builder with a talent for creative problem solving & execution. You are excellent at communicating audit & compliance concepts to colleagues in other functions.

You will focus on: Technical chart auditing, Epic work queue 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

Preferred Qualifications:

• CRC
• RHIT or RHIA

Oak Street Health is on a mission to "Rebuild healthcare as it should be'', providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patient's communities, and focused on the quality of care over volume of services. We're an organization on the move! With over 150 locations and an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody "Oaky" values and passion for our mission.

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.