Senior Coding Data Quality Auditor, Regulatory Compliance - Remote

Overview

As a Senior Coding Data Quality Auditor at CVS Health, you will play a crucial role in ensuring coding accuracy and data integrity, impacting compliance and financial performance while working from home.

In Short

• Perform quality inter-rater review audits of medical records.
• Ensure compliance with ICD coding standards.
• Support coding judgment and decisions with industry evidence.
• Mentor internal staff based on audit findings.
• Conduct process audits for compliance with policies.
• Identify documentation deficiencies for continuous education.
• Work independently and collaborate across teams.
• Adhere to project deadlines and directives.
• Extensive knowledge of medical documentation and coding violations.
• Engage in continuous improvement initiatives.

Requirements

• Minimum 3 years of experience in medical record documentation review.
• CPC or CCS-P certification required.
• Experience with ICD codes and risk adjustment processes.
• Computer proficiency in Microsoft Office products.
• Strong understanding of coding guidelines and regulations.
• Ability to communicate effectively with various stakeholders.
• Knowledge of fraud, abuse, and penalties in coding.
• Education equivalent to AA/AS or completion of AAPC/AHIMA training program.

Benefits

• Comprehensive medical plan options.
• 401(k) plan with company matching contributions.
• No-cost wellness programs and confidential counseling.
• Flexible work schedules and paid time off.
• Tuition assistance and retiree medical access.
• Employee stock purchase plan.
• Colleague assistance programs and family leave.
• Programs addressing diverse needs and preferences.