Risk-Adjustment Medical Coding Data Auditor

Internationalinsuranceprofessionals; United States; Remote; USD 29,000 - 62,000; Full time

Job summary

CVS Health is seeking a qualified auditor to review medical records for CMS risk adjustment accuracy. You will verify ICD-10 codes and ensure documentation supports coding decisions, while mentoring staff on coding standards.

Responsibilities include leading dispute resolution, communicating findings to stakeholders, and driving process improvements to maintain high quality and compliance with CMS and HIPAA requirements.

Qualifications

• 5+ years in medical record documentation review, diagnosis coding or auditing.
• Experience with Medicare/Medicaid risk adjustment and HCCs.
• CPC/CCS-P/CRC certifications required.
• Proficient with Microsoft Office and coding applications.

Responsibilities

• Perform quality inter-rater review audits of medical records for CMS risk adjustment.
• Ensure ICD-10 codes are accurate, appropriate and well supported by documentation.
• Lead dispute resolution and mentor staff on ICD coding practices.
• Communicate audit results to clinical, coding, and management teams.
• Identify process improvements to enhance productivity and accuracy.

Skills

MS Office

ICD coding

Medical records auditing

Risk adjustment

CPC/CCS-P/CRC

Education

Bachelor's degree

AAPC/AHIMA credentials CPC/CCS-P/CRC training

Job description

CVS Health is seeking a qualified auditor to review medical records for CMS risk adjustment accuracy. You will verify ICD-10 codes and ensure documentation supports coding decisions, while mentoring staff on coding standards.

Responsibilities include leading dispute resolution, communicating findings to stakeholders, and driving process improvements to maintain high quality and compliance with CMS and HIPAA requirements.