Coding Data Quality Auditor
Pubblicato il 12-08-2026 - Iniziative benefiche e non lucrative in Leivi
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, 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.
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Position Summary
Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD 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.
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.
Sound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity.
Identify clinically active vs. historical conditions.
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.
Adhere to stringent timelines consistent with project deadlines and directives.
Conducts self‑process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other regulatory bodies.
Requ