Risk-Adjustment Medical Coding Auditor

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

Job summary

CVS Health is seeking a detail-oriented coder/auditor to perform medical record abstraction and CMS ICD coding validation. The role focuses on risk adjustment accuracy, documentation support, and regulatory compliance across provider records in a full-time capacity.

Responsibilities include conducting audits, ensuring medical necessity, and meeting tight deadlines while upholding HIPAA standards for patient data. A CPC/CCS-P certification is required along with proficiency in MS Office.

Qualifications

• CPC or CCS-P certification required.
• Proficient with Word, Excel, Access, PowerPoint, Outlook.
• Experience with ICD coding and medical records review.

Responsibilities

• Audit and abstract provider/provider medical records to identify CMS ICD codes.
• Validate codes for risk adjustment accuracy and regulatory compliance.
• Ensure diagnoses are supported by documentation and medical necessity.
• Perform self-audit to ensure policy and CMS guidance compliance.
• Maintain HIPAA privacy and security for patient data.
• Meet project deadlines and deliver timely audits.

Skills

CPC/CCS-P

MS Office

Outbound calls

ICD coding

Medical record review

Education

AA/AS or equivalent

AAPC/AHIMA CPC/CCS-P training

Job description

CVS Health is seeking a detail-oriented coder/auditor to perform medical record abstraction and CMS ICD coding validation. The role focuses on risk adjustment accuracy, documentation support, and regulatory compliance across provider records in a full-time capacity.

Responsibilities include conducting audits, ensuring medical necessity, and meeting tight deadlines while upholding HIPAA standards for patient data. A CPC/CCS-P certification is required along with proficiency in MS Office.