LogoFresh Jobs Ahead
CVS Health
CVS Health
HealthcareHealthcare InsuranceRetail
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.
LinkedIn
Company Jobs

Remote Medical Coding Quality Auditor at CVS Health

Review medical records, validate ICD risk-adjustment diagnoses, and support compliance with CMS requirements at CVS Health. This U.S.-remote position calls for a coding certification and relevant medical-record auditing experience.

USUnited StatesALAlabamaAZArizonaCACaliforniaCOColoradoCTConnecticutFLFloridaIDIdahoILIllinoisIAIowaKSKansasKYKentuckyLALouisianaMEMaineMDMarylandMAMassachusettsMIMichiganMNMinnesotaMSMississippiMOMissouriMTMontanaNENebraskaNVNevadaNHNew HampshireNJNew JerseyNMNew MexicoNYNew YorkNCNorth CarolinaNDNorth DakotaOHOhioOKOklahomaOROregonPAPennsylvaniaRIRhode IslandSCSouth CarolinaSDSouth DakotaTNTennesseeTXTexasUTUtahVTVermontVAVirginiaWAWashingtonWVWest VirginiaWIWisconsinWYWyoming
$18 – $38 / hour
RemoteFull-timeJuniorEnglish RequiredAuditor

Description

  • Review provider and vendor medical records and identify ICD codes submitted to CMS.
  • Check risk-adjustment codes for accuracy, supporting documentation, and compliance with applicable regulations and company policies.
  • Use industry-standard evidence and tools to support coding decisions.
  • Assign accurate medical codes to diagnoses documented by physicians and other qualified healthcare providers.
  • Follow coding rules and regulations, including medical-necessity requirements.
  • Distinguish active clinical conditions from historical ones.
  • Confirm that diagnosis codes are appropriate, accurate, and supported by clinical records.
  • Check whether records support the documented disease causes and manifestations.
  • Complete work within project deadlines and assigned timelines.
  • Audit your own work for compliance with company policies and guidance from CMS, OIG, and other regulators.
  • Handle patient information ethically and in keeping with HIPAA requirements.
  • Carry out other related duties as needed.

Requirements

  • Hold a CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) credential.
  • Be proficient with computers, Microsoft Office applications (Word, Excel, Access, PowerPoint, Outlook), and standard coding software.
  • Be able to place outbound calls and send faxes to providers.
  • Have experience using International Classification of Diseases (ICD) codes.
  • Have at least one year of recent, relevant experience reviewing medical-record documentation, coding diagnoses, and/or auditing.
  • Have an AA/AS degree or equivalent experience.
  • Complete an AAPC or AHIMA training program for a core credential (CPC or CCS-P), with related work history or on-the-job experience equivalent to approximately 1–2 years for CPC.
  • Know medical terminology and anatomy across all body systems.
  • Understand the audit process for risk-adjustment models.
  • Be able to follow HIPAA Privacy and Security rules and applicable regulations.
  • Preferred: Have three years of recent, relevant experience reviewing medical-record documentation, coding diagnoses, and/or auditing.
  • Preferred: Have experience with Medicare, commercial, and/or Medicaid risk-adjustment processes and Hierarchical Condition Categories.
  • Preferred: Hold a CPMA, CDEO, or CPC-I certification.
  • Preferred: Bring strong analytical, problem-solving, communication, organizational, and interpersonal skills.

Benefits

  • May be eligible for a CVS Health bonus, commission, or short-term incentive in addition to base pay.
  • Medical coverage.
  • Dental coverage.
  • Vision coverage.
  • Paid time off.
  • Retirement savings options.
  • Wellness programs.
  • Resources for physical, emotional, and financial well-being.