Medical Coding & Data Quality Auditor

Internationalinsuranceprofessionals; Pennsylvania; On-site; USD 26,000 - 52,000; Full time

Job summary

CVS Health is seeking a skilled Medical Records Auditor/Coder to perform audit and abstraction of provider and vendor medical records to identify CMS ICD codes. You will validate codes for risk adjustment, ensure documentation supports medical necessity, and maintain compliance with HIPAA and regulatory guidelines.

The role involves working with clinical documentation, coordinating record retrieval with providers, and meeting tight project timelines.

Qualifications

• AA/AS or equivalent experience.
• Completion of AAPC/AHIMA training program for CPC/CCS-P with related on-the-job experience.

Responsibilities

• Audit and abstract provider/vendor medical records to identify CMS ICD codes.
• Validate codes for risk adjustment accuracy and medical necessity.
• Ensure documentation supports codes across state and federal regulations.

Skills

Medical coding knowledge

HIPAA compliance

Record retrieval coordination

Auditing experience

Education

AA/AS or equivalent experience

CPC/CCS-P credential training

Tools

Microsoft Office

Coding applications

Job description

CVS Health is seeking a skilled Medical Records Auditor/Coder to perform audit and abstraction of provider and vendor medical records to identify CMS ICD codes. You will validate codes for risk adjustment, ensure documentation supports medical necessity, and maintain compliance with HIPAA and regulatory guidelines.

The role involves working with clinical documentation, coordinating record retrieval with providers, and meeting tight project timelines.