Manager, Coding Quality and Compliance Auditing

Oak Street Health, part of CVS Health; United States; On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Health insurance

401K retirement matching

Paid vacation

Job summary

Oak Street Health, part of CVS Health, seeks a Manager of Coding Quality and Compliance to lead technical chart auditing, Epic queue rule maintenance, and external CMS RADV readiness. You will drive AHIMA/ACDIS-compliant provider query governance and ensure accurate risk adjustment documentation across centers.

You will collaborate with Rev Cycle, Coding, and Clinical Documentation teams, translating high-risk conditions into compliant Epic configurations while tracking deletion logs and

Qualifications

• 5 to 7 years of relevant experience in medical coding and/or risk adjustment.
• 2 to 4 years of risk-adjusted coding experience.
• Certifications CCS, CCA, or CPC; AHIMA or AAPC credential current.
• ICD-10-CM, ICD-9-CM, CPT, HCPCS coding experience required.
• Experience with clinical documentation, audits, and Epic workflows is a plus.

Responsibilities

• Conducts daily quality checks and secondary reviews to ensure coding compliance (ICD-10-CM, CPT, HCPCS) and accurate E/M coding.
• Oversees external CMS RADV audits and internal RADV readiness, including mock audits.
• Audits and enforces compliant provider query practices per AHIMA/ACDIS standards.
• Partner with IT to translate high-risk OIG criteria into native Epic rule engine logic.
• Maintain deletion log and oversee overpayment refund processes per federal timelines.
• Audit payer data ingestions to ensure CMS-compliant chronic condition coding.

Skills

Auditing expertise

Medical terminology knowledge

Stakeholder communication

Compliance awareness

Problem solving

Education

CCS/CCA/CPC certification

ICD-10 Coding certification

AHIMA or AAPC credential (current)

Post-secondary / high school education or specialized training

Job 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
• Prior medical chart auditing/quality experience
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes and pharmacology

Preferred Qualifications:

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.

• 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.