Risk-Adjustment Medical Coding Auditor

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

Job summary

CVS Health is hiring a Provider Records Auditor to audit and abstract medical records, verify ICD codes, and ensure risk adjustment processes comply with CMS, state, and federal regulations.

You will apply industry‑standard coding tools, communicate with providers, meet project deadlines, and uphold HIPAA privacy and security rules.

This full‑time position includes a comprehensive benefits package and bonus eligibility, with a competitive hourly base rate and opportunities for professional growth.

Qualifications

• CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required.
• Computer proficiency including Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications).
• Experience with ICD codes required.
• Minimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.

Responsibilities

• Audit and abstract provider and/or vendor medical records to identify ICD codes for CMS submissions.
• Validate codes used for risk adjustment are accurate, documented, and compliant with regulations and policies.
• Identify clinically active vs. historical conditions and ensure codes are supported by documentation.
• Adhere to deadlines and conduct self-audits to ensure regulatory compliance.
• Maintain HIPAA Privacy and Security compliance in handling patient data.

Skills

CPC/CCS-P credential

MS Office proficiency

Medical terminology knowledge

Education

AA/AS or equivalent experience

CPC/CCS-P credential training program

Tools

ICD codes

Coding applications

Job description

CVS Health is hiring a Provider Records Auditor to audit and abstract medical records, verify ICD codes, and ensure risk adjustment processes comply with CMS, state, and federal regulations.

You will apply industry‑standard coding tools, communicate with providers, meet project deadlines, and uphold HIPAA privacy and security rules.

This full‑time position includes a comprehensive benefits package and bonus eligibility, with a competitive hourly base rate and opportunities for professional growth.