Risk Adjustment Data Quality Auditor

Internationalinsuranceprofessionals; Washington; On-site; USD 38,000 - 81,000; Full time

Job summary

CVS Health is seeking a provider data auditor to review and abstract medical records, ensuring accurate CMS coding and risk adjustment documentation across hospital and office settings. The role requires CPC/CCS-P, proficiency with Microsoft Office, and the ability to coordinate with providers by phone or fax while maintaining HIPAA compliance and meeting tight deadlines.

You will work in a collaborative team focused on quality and regulatory adherence, applying coding guidelines and CMS rules

Qualifications

• 1 year of recent experience in medical record documentation review, diagnosis coding, or auditing.
• Certification CPC or CCS-P required.
• Proficient in Microsoft Office and coding applications.
• Ability to contact providers for record retrieval via phone or fax.

Responsibilities

• Audit and abstract provider or vendor medical records to identify CMS codes.
• Validate accurate, compliant risk adjustment codes and documentation.
• Adhere to HIPAA privacy and security rules when handling patient data.
• Meet strict timelines and perform self-audits for compliance.
• Communicate findings and collaborate with healthcare providers.

Skills

Medical coding

Provider outreach

Microsoft Office

HIPAA compliance

Education

AA/AS or equivalent

CPC/CCS-P training

Tools

Microsoft Office suite

Coding applications

Job description

CVS Health is seeking a provider data auditor to review and abstract medical records, ensuring accurate CMS coding and risk adjustment documentation across hospital and office settings. The role requires CPC/CCS-P, proficiency with Microsoft Office, and the ability to coordinate with providers by phone or fax while maintaining HIPAA compliance and meeting tight deadlines.

You will work in a collaborative team focused on quality and regulatory adherence, applying coding guidelines and CMS rules