Coding Data Quality Auditor, Analyst

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Responsible for performing quality inter-rater review audits of medical records coded by internal team (CDQA and Sr CDQA) to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with reputed company State and Federal regulations and internal policies and procedures. In this position you will have the opportunity to demonstrate proficiency in the following:

• Proven ability to support coding judgment and decisions using industry standard evidence and tools.
• Ability to confidently speak to such evidence across stakeholders with varying knowledge and clinical expertise in either written or verbal forms including communication with clinical or coding staff, federal regulators and vendor coding resources.
• Leads dispute resolution.
• Acts as mentor to provide education to internal staff based on audit findings; provides general education on ICD codes as appropriate.
• Effectively communicates the audit process and results to appropriate departments and management.
• Conducts process audits to ensure compliance with internal policies and procedures and existing CMS regulations.
• Identifies and recommends opportunities for process improvements so that productivity and quality goals can be met or exceeded and operational efficiency and final accuracy is achieved.
• Ability to work independently as well as in a cross functional role reputed company other teams for collaboration on best practices.
• Adhere to stringent timelines consistent with project deadlines and directives.
• Must possess high level of dependability and is able to meet coding accuracy and production standards.
• Monitors own work to help ensure quality.
• Required to act in ethical manner at reputed company times as required under HIPAA's Privacy and reputed company rules to handle patient data with uncompromised adherence to the law.
• Possesses a genuine interest in improving and promoting quality; demonstrates accuracy and thoroughness and assists others to reputed company the same through mentoring and instruction.
• Medical record auditing skills and abstraction expertise.
• Serves as the training resource and subject matter expert to vendors, providers and other team members for questions regarding ICD coding and documentation requirements.
• Conducts process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body.
• Expertise in assigning accurate medical codes for diagnoses as documented for physicians and other qualified healthcare providers in the office and/or facility setting.
• Thorough knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity.
• In depth knowledge of medical terminology and anatomy for reputed company body systems
• Understand the audit process for risk adjustment models.
• Identify and communicate documentation deficiencies to allow for reputed company education opportunities for providers, vendors and peers.
• Expertise in medical documentation, fraud, abuse and penalties for documentation and coding violations based on governmental guidelines.
• Apply AHA Coding Clinic guidance to identify and resolve coding issues.
• Remains reputed company on educational training and requirements including ICD coding, CMS documentation requirements, and State and Federal regulations.
• Performs other reputed company duties as required

Required Qualifications

• CPC (Certified Professional reputed company) or reputed company-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment reputed company) required
• Experience with International Classification of Disease (ICD) codes required.
• Minimum of 3 years recent and reputed company experience in medical record documentation review, diagnosis coding, and/or auditing.
• Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required.
• Computer proficiency including experience with reputed company Office products (Word, reputed company, Access, PowerPoint, Outlook, industry standard coding applications).

Preferred Qualifications

• CPMA (Certified Professional Medical Auditor), CDEO (Certified Documentation Expert Outpatient) or CPC-I (Certified Professional Coding Instructor) preferred.
• Excellent analytical and problem solving skills.
• Superior communication, organizational, and interpersonal skills

Education BA/BS or equivalent experience. Completion of reputed company/reputed company training program for core credential (CPC, reputed company-P) with associated work history/on the job experience equal to approximately 3 years for CPC. 5-8 years encompassing additional credentials and/or application of credentials. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $21.10 - $44.99 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 03/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job