Coding Data Quality Auditor

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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit 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 all 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.
• Proficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other qualified healthcare providers in the office and/or facility setting.
• Thorough grasp of anatomy, physiology and medical terminology to comprehend clinical documentation and code descriptions. 
• Sound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity.
• Identify clinically active vs. historical conditions
• Expertise in medical documentation requirements
• Diagnosis codes must be appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.
• Utilize medical records to ensure support is documented for etiology and manifestations of disease processes. 
• Ability to support coding judgment and decisions using industry standard evidence and tools.
• Assists senior level staff in providing recommendations for process improvement so that productivity and quality goals can be met or exceeded, and operational efficiency and financial accuracy can be achieved.
• Adhere to stringent timelines consistent with project deadlines and directives.
• Must possess high level of dependability and ability to meet coding accuracy and production standards.
• Monitors own work to help ensure quality.
• Required to always act in ethical manner as required under HIPAA's Privacy and Security rules to handle patient data with uncompromised adherence to the law.
• Performs other related duties as required.

Required Qualifications

• CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required.
• Minimum of 3 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
• Minimum of 3 years of experience with International Classification of Disease (ICD) codes required.
• Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, and industry standard coding applications).

Preferred Qualifications

• Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred.
• CRC (Certified Risk Adjustment Coder) preferred.
• Excellent analytical and problem-solving skills.
• Demonstrated communication, organizational, and interpersonal skills.

Education

• Associates degree or equivalent experience.
• Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on the job experience equal to approximately 3 years for CPC.

Pay Range

The typical pay range for this role is:

$18.50 - $31.72

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 11/07/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.