Risk-Adjustment Medical Coding Data Quality Auditor

CVSHealth; California (MO); On-site; USD 44,000 - 77,000; Full time

Job summary

CVS Health is seeking a Coding Data Quality Audit Analyst to perform second-level quality inter-rater reviews of medical records coded by internal teams and external vendors. The role ensures ICD codes submitted to CMS for risk adjustment are accurate and supported by clinical documentation in line with regulations.

The position requires CPC/CCS-P certification, 3 years of relevant experience, and a strong focus on quality improvement, education, and cross-functional collaboration.

Qualifications

• Minimum of 3 years of recent, related experience in medical record documentation review, diagnosis coding, and/or auditing.
• Associate degree (AA/AS) or equivalent experience.
• Completion of an AAPC or AHIMA training program for a core credential (CPC or CCS-P), with associated work history and on-the-job experience equivalent to approximately 3 years for CPC certification.
• CPC or CCS-P certification required.

Responsibilities

• Demonstrates the ability to support coding judgments and decisions using industry-standard evidence and tools.
• Communicates supporting evidence to internal stakeholders with varying levels of coding and clinical expertise.
• Mentors internal staff based on audit findings and education on ICD coding.
• Conducts process audits to ensure compliance with policies and CMS regulations.

Skills

Medical record review

Diagnosis coding

Auditing

Education

Associate degree or equivalent

Bachelor’s degree preferred

Tools

CPC or CCS-P certification

Job description

CVS Health is seeking a Coding Data Quality Audit Analyst to perform second-level quality inter-rater reviews of medical records coded by internal teams and external vendors. The role ensures ICD codes submitted to CMS for risk adjustment are accurate and supported by clinical documentation in line with regulations.

The position requires CPC/CCS-P certification, 3 years of relevant experience, and a strong focus on quality improvement, education, and cross-functional collaboration.