Analyst, Coding Data Quality Audit

This is a fully remote position, open to applicants in Alabama, +41 more states.

📋 Description

• Conduct second-level quality audits of medical records coded by both internal teams and external vendors, if necessary.

• Verify that ICD codes submitted to CMS for risk adjustment are suitable, precise, and backed by clinical documentation.

• Assist in coding judgments and decisions utilizing industry-standard evidence and tools.

• Convey supporting evidence to internal stakeholders with varying levels of coding and clinical knowledge.

• Guide and train internal staff based on the findings from audits.

• Provide general education on ICD coding as deemed appropriate.

• Execute process audits to ensure compliance with internal policies, procedures, CMS regulations, OIG guidance, and other regulatory standards.

• Operate both independently and collaboratively within cross-functional teams to foster best practices.

• Identify and report documentation deficiencies to aid in peer education and development.

• Stay informed about coding guidelines, medical necessity, documentation requirements, and regulations related to fraud and abuse.

⛳️ Requirements

• A minimum of 3 years of recent, relevant experience in medical record documentation review, diagnosis coding, and/or auditing.

• An Associate degree (AA/AS) or equivalent experience.

• Successful completion of an AAPC or AHIMA training program for a core credential (CPC or CCS-P), with an associated work history and on-the-job experience equivalent to approximately 3 years for CPC certification.

• Certification as a CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) is mandatory.

• CRC (Certified Risk Adjustment Coder) certification must be obtained within the first six months.

• Familiarity with coding guidelines and regulations.

• Understanding of medical documentation requirements, fraud and abuse regulations, and the penalties related to documentation and coding violations.

• Capability to support coding judgments using industry-standard evidence and tools.

• Proficiency in communicating evidence to internal stakeholders, clinical staff, coding personnel, federal regulators, and vendor coding resources.

• Ability to work both independently and collaboratively within cross-functional teams.

• Competence in meeting stringent timelines and project deadlines.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, subject to eligibility.