Medical Records Coding Quality Auditor

CVS Health; Philadelphia (Philadelphia County); On-site; USD 25,000 - 49,000; Full time

Job summary

CVS Health is seeking an experienced Medical Records Auditor to perform abstraction and coding for CMS risk adjustment programs. You will verify accuracy of diagnoses and ensure documentation supports medical necessity in line with regulations.

The role requires CPC/CCS-P certification or training, 1+ year of related experience, and proficiency with ICD codes, MS Office, and coding software. Full-time, on-site in Philadelphia area.

Qualifications

• AA/AS or equivalent experience.
• CPC or CCS-P certification required.
• Experience with ICD codes required.
• Proficient with MS Office and coding applications.
• Knowledge of CMS/OIG regulatory guidance.

Responsibilities

• Support coding judgment using industry standards and tools.
• Abstract and assign accurate medical codes as documented by clinicians.
• Follow coding guidelines to meet compliance and medical necessity.
• Identify clinically active vs historical conditions.
• Ensure codes are accurate and supported by documentation per regulations.
• Use records to document etiology and manifestations.
• Adhere to timelines per project deadlines.
• Perform self-audit to ensure CMS/OIG compliance.

Skills

Medical record auditing

ICD coding

Regulatory compliance

Timeline adherence

CMS regulations

Education

AA/AS or equivalent experience

AAPC/AHIMA CPC/CCS-P certification training

Tools

Microsoft Office

Coding applications

Job description

CVS Health is seeking an experienced Medical Records Auditor to perform abstraction and coding for CMS risk adjustment programs. You will verify accuracy of diagnoses and ensure documentation supports medical necessity in line with regulations.

The role requires CPC/CCS-P certification or training, 1+ year of related experience, and proficiency with ICD codes, MS Office, and coding software. Full-time, on-site in Philadelphia area.