Senior Coding Quality & Compliance Lead – Epic & RADV Audits

CVS Health; Illinois; Hybrid; USD 66,000 - 146,000; Full time

Benefits offered by this job

Paid time off

401K match

Health insurance

Job summary

Oak Street Health, part of CVS Health, seeks an experienced Manager of Coding Quality and Compliance to lead chart auditing, Epic rule engine optimization, and external CMS RADV readiness. You will collaborate with Rev Cycle, Coding, Clinical Documentation, and leadership to ensure accurate coding and compliant documentation.

The role emphasizes maternal risk adjustment workflows, deletion/log reconciliation, and payer data auditing to maintain CMS standards and protect program integrity.

Qualifications

• 5 to 7 years relevant experience required.
• Credential of AHIMA or AAPC required; dual certification a plus.
• ICD-10-CM coding certification required; ICD-9-CM experience beneficial.

Responsibilities

• Conducts daily quality checks and secondary reviews to verify coding guide compliance (ICD-10-CM, CPT, HCPCS).
• Manages external CMS RADV audits and internal readiness, including mock RADV audits.
• Audits and enforces AHIMA/ACDIS-compliant query practices across coding staff.
• Translates high-risk OIG parameters into native Epic tools with IT teams.
• Tracks deletion log processes and ensures 60-day overpayment refund adherence.
• Audits payer data to validate CMS coding standards before risk-score submission.

Skills

Risk-adjusted coding

Audit/quality experience

Epic workflow understanding

Communication of audits

Deletion log tracking

Education

CCS

CCA

CPC

AHIMA or AAPC credential

ICD-10-CM certification

ICD-9-CM experience

ICD-10-CM experience

Tools

Job description

Oak Street Health, part of CVS Health, seeks an experienced Manager of Coding Quality and Compliance to lead chart auditing, Epic rule engine optimization, and external CMS RADV readiness. You will collaborate with Rev Cycle, Coding, Clinical Documentation, and leadership to ensure accurate coding and compliant documentation.

The role emphasizes maternal risk adjustment workflows, deletion/log reconciliation, and payer data auditing to maintain CMS standards and protect program integrity.