Risk-Adjustment Medical Coding Auditor

CVS Health; South Dakota; Hybrid; USD 25,000 - 53,000; Full time

Benefits offered by this job

Bonus program

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a qualified coder/auditor to review provider and vendor medical records for CMS ICD codes and risk adjustment accuracy. You will validate documentation, ensure compliance with state and federal regulations, and support coding judgments with industry guidelines.

responsibilities include outbound provider communications, adherence to HIPAA, and timely completion of audits. AAA/AS or equivalent with CPC/CCS-P training is preferred, with 1+ year of related experience.

Qualifications

• CPC or CCS-P certification required.
• Experience with ICD coding and medical records review.
• Proficient in Microsoft Office and coding applications.
• Ability to make outbound calls/faxes to providers for record retrieval.
• Minimum 1 year related experience in medical record documentation review or auditing.

Responsibilities

• Audit and abstract provider/vendor records to identify CMS ICD codes.
• Validate codes for risk adjustment accuracy and regulatory compliance.
• Ensure codes are supported by documentation and applied per guidelines.
• Adhere to HIPAA and maintain patient data privacy.
• Meet project deadlines and conduct self-audit checks.

Skills

ICD coding experience

Medical records abstraction

Regulatory compliance

Education

AA/AS or equivalent experience

CPC or CCS-P credential training program completion

Tools

Microsoft Office

Coding applications

Job description

CVS Health is seeking a qualified coder/auditor to review provider and vendor medical records for CMS ICD codes and risk adjustment accuracy. You will validate documentation, ensure compliance with state and federal regulations, and support coding judgments with industry guidelines.

responsibilities include outbound provider communications, adherence to HIPAA, and timely completion of audits. AAA/AS or equivalent with CPC/CCS-P training is preferred, with 1+ year of related experience.