Data Quality Auditor

This is a fully remote position, open to applicants in Alabama, +27 more states.

📋 Description

• Conduct audits and abstraction of medical records from healthcare providers and/or vendors.

• Identify and submit appropriate, precise, and clinically substantiated ICD codes to CMS for risk adjustment procedures.

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

• Abstract and assign accurate medical codes for diagnoses documented by physicians and other qualified healthcare practitioners in both office and facility settings.

• Implement coding guidelines and regulations, including the criteria for establishing medical necessity.

• Distinguish between clinically active and historical conditions.

• Utilize medical records to confirm documentation supporting disease etiology and manifestations.

• Adhere to strict timelines in accordance with project deadlines and directives.

• Perform self-process audits to ensure compliance with internal policies, procedures, and regulatory guidance from CMS, OIG, and other regulatory entities.

⛳️ Requirements

• At least 1 year of recent and relevant experience in medical record documentation review, diagnosis coding, and/or auditing.

• CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) certification is required.

• Proficiency in computer applications, including Microsoft Office Suite (Word, Excel, Access, PowerPoint, Outlook) and industry-standard coding software.

• Experience with International Classification of Disease (ICD) codes is necessary.

• CRC (Certified Risk Adjustment Coder) certification is preferred.

• Familiarity with Medicare and/or Commercial and/or Medicaid Risk Adjustment processes and Hierarchical Condition Categories (HCC) is preferred.

• AA/AS degree or equivalent experience is required.

• Completion of an AAPC/AHIMA training program for core credentials (CPC, CCS-P), along with associated work history/on-the-job experience totaling approximately 1–2 years for CPC.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, depending on eligibility.