Senior Coding Quality & Compliance Lead (Epic/RADV)

Oak Street Health, part of CVS Health; United States; On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Health insurance

401K retirement matching

Paid vacation

Job summary

Oak Street Health, part of CVS Health, seeks a Manager of Coding Quality and Compliance to lead technical chart auditing, Epic queue rule maintenance, and external CMS RADV readiness. You will drive AHIMA/ACDIS-compliant provider query governance and ensure accurate risk adjustment documentation across centers.

You will collaborate with Rev Cycle, Coding, and Clinical Documentation teams, translating high-risk conditions into compliant Epic configurations while tracking deletion logs and

Qualifications

• 5 to 7 years of relevant experience in medical coding and/or risk adjustment.
• 2 to 4 years of risk-adjusted coding experience.
• Certifications CCS, CCA, or CPC; AHIMA or AAPC credential current.
• ICD-10-CM, ICD-9-CM, CPT, HCPCS coding experience required.
• Experience with clinical documentation, audits, and Epic workflows is a plus.

Responsibilities

• Conducts daily quality checks and secondary reviews to ensure coding compliance (ICD-10-CM, CPT, HCPCS) and accurate E/M coding.
• Oversees external CMS RADV audits and internal RADV readiness, including mock audits.
• Audits and enforces compliant provider query practices per AHIMA/ACDIS standards.
• Partner with IT to translate high-risk OIG criteria into native Epic rule engine logic.
• Maintain deletion log and oversee overpayment refund processes per federal timelines.
• Audit payer data ingestions to ensure CMS-compliant chronic condition coding.

Skills

Auditing expertise

Medical terminology knowledge

Stakeholder communication

Compliance awareness

Problem solving

Education

CCS/CCA/CPC certification

ICD-10 Coding certification

AHIMA or AAPC credential (current)

Post-secondary / high school education or specialized training

Job description

Oak Street Health, part of CVS Health, seeks a Manager of Coding Quality and Compliance to lead technical chart auditing, Epic queue rule maintenance, and external CMS RADV readiness. You will drive AHIMA/ACDIS-compliant provider query governance and ensure accurate risk adjustment documentation across centers.

You will collaborate with Rev Cycle, Coding, and Clinical Documentation teams, translating high-risk conditions into compliant Epic configurations while tracking deletion logs and