Medical Coding & Data Quality Auditor (Risk Adjustment)

Internationalinsuranceprofessionals; Utah; On-site; USD 25,000 - 54,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings

Job summary

CVS Health is seeking a qualified Medical Records Auditor to audit and abstract records for CMS risk adjustment, ensuring accurate ICD coding and regulatory compliance. Role spans office or facility settings, requiring attention to documentation and timelines.

Must have CPC/CCS-P certification and at least 1 year of related experience; strong communication with providers and proficiency in Microsoft Office are essential.

Qualifications

• CPC or CCS-P certification required.
• Experience with ICD coding and medical record documentation review.
• Proficient with Microsoft Office suite.
• Ability to make outbound provider calls and communications.
• Minimum 1 year of related experience in medical record review, diagnosis coding, and/or auditing.

Responsibilities

• Audit and abstract medical records to identify CMS ICD codes.
• Validate coding accuracy for risk adjustment processes.
• Ensure compliance with state and federal regulations and internal policies.
• Identify clinically active vs historical conditions.
• Meet project deadlines and directives; maintain HIPAA compliance.

Skills

CPC/CCS-P

Microsoft Office

Outreach to providers

ICD coding

Medical records review

Education

AA/AS or equivalent

CPC/CCS-P training

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

PowerPoint

Outlook

Job description

CVS Health is seeking a qualified Medical Records Auditor to audit and abstract records for CMS risk adjustment, ensuring accurate ICD coding and regulatory compliance. Role spans office or facility settings, requiring attention to documentation and timelines.

Must have CPC/CCS-P certification and at least 1 year of related experience; strong communication with providers and proficiency in Microsoft Office are essential.