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CVS Health is an American healthcare company working across healthcare services, health insurance, pharmacy benefits management, and retail pharmacy. Through businesses including Aetna and CVS Caremark, it supports health coverage, prescription access, condition management, specialty medications, and mail-order pharmacy services. Its neighborhood pharmacies and broader care offerings are designed to help people access essential healthcare more conveniently and affordably. CVS Health brings together insurance, pharmacy, and health services to support individuals and communities throughout their care journeys.
Remote Data Quality Auditor, Medical Coding — CVS Health
Review medical records and ICD codes for CVS Health’s risk adjustment programs. Support accurate clinical documentation, coding, and regulatory compliance.
United States
Alabama
Idaho
Iowa
Kansas
Kentucky
Louisiana
Michigan
Minnesota
Mississippi
Missouri
Montana
New Jersey
New Mexico
North Carolina
North Dakota
Ohio
Oklahoma
Pennsylvania
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
West Virginia
Wisconsin
Wyoming$18 – $35 / hour
RemoteFull-timeJuniorEnglish RequiredAuditorDescription
- Audit and abstract medical records received from providers and vendors.
- Select and submit accurate, clinically supported ICD codes to CMS for risk adjustment.
- Use industry-standard evidence and tools to support coding decisions.
- Assign medical codes to diagnoses documented by physicians and other qualified providers in office or facility settings.
- Apply coding rules and regulations, including medical necessity requirements.
- Distinguish active clinical conditions from historical ones.
- Verify medical record documentation for disease causes and manifestations.
- Complete work within project deadlines and other specified timelines.
- Audit personal processes for compliance with internal procedures and guidance from CMS, OIG, and other regulators.
Requirements
- At least one year of recent, related experience reviewing medical record documentation, coding diagnoses, and/or conducting audits.
- CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) certification.
- Computer skills, including Microsoft Office applications (Word, Excel, Access, PowerPoint, and Outlook) and standard coding software.
- Experience using International Classification of Diseases (ICD) codes.
- CRC (Certified Risk Adjustment Coder) certification preferred.
- Experience with Medicare, commercial, and/or Medicaid risk adjustment processes and Hierarchical Condition Categories (HCC) preferred.
- AA/AS degree or equivalent experience.
- Completion of an AAPC or AHIMA training program for a core credential (CPC or CCS-P), with related work history or on-the-job experience totaling approximately one to two years for CPC.
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.
- Other resources for physical, emotional, and financial well-being, subject to eligibility.
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