Medical Coding & Data Quality Auditor

Internationalinsuranceprofessionals; Massachusetts; On-site; USD 53,010,000 - 111,236,000; Full time

Job summary

CVS Health is seeking a Medical Records Auditor with expertise in CPT/ICD coding to review and abstract provider records for Medicare risk adjustment. You will ensure codes are accurate, documentation supports diagnoses, and regulatory requirements are met.

The role requires CPC/CCS-P certification, experience with ICD coding, and proficiency with Microsoft Office. Expect full-time hours and a comprehensive benefits package in a collaborative, compliance-driven environment.

Qualifications

• CPC or CCS-P certification is required.
• Experience with ICD coding and medical record abstraction.
• Proficiency with Microsoft Office and coding applications.
• Minimum 1 year of related experience in medical records review or auditing.
• HIPAA privacy and security knowledge is expected.

Responsibilities

• Audit and abstract provider and/or vendor medical records to identify ICD codes.
• Validate codes used for risk adjustment are accurate and compliant with regulations and policies.
• Identify clinically active vs. historical conditions and ensure documentation supports etiology and manifestations.
• Adhere to timelines and project deadlines.
• Perform self-audit to ensure compliance with policies and regulatory guidance.
• Handle patient data in a compliant, ethical manner under HIPAA rules.

Skills

CPC/CCS-P certification

ICD coding

Medical records review

Auditing

Microsoft Office

Education

AA/AS or equivalent experience

CPC/CCS-P credential training program completed

Tools

Microsoft Office

Job description

CVS Health is seeking a Medical Records Auditor with expertise in CPT/ICD coding to review and abstract provider records for Medicare risk adjustment. You will ensure codes are accurate, documentation supports diagnoses, and regulatory requirements are met.

The role requires CPC/CCS-P certification, experience with ICD coding, and proficiency with Microsoft Office. Expect full-time hours and a comprehensive benefits package in a collaborative, compliance-driven environment.