Data Quality Audit Analyst

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🔥 0 minutes ago

🏈 Alabama, Arizona, +34 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🦬 Wyoming – Remote

💵 $21 - $44 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Perform second-level quality inter-rater review audits of medical records coded by internal teams and external vendors, when applicable • Ensure ICD codes submitted to CMS for risk adjustment are appropriate, accurate, and supported by clinical documentation • Support coding judgments and decisions using industry-standard evidence and tools • Communicate supporting evidence to internal stakeholders, clinical staff, coding staff, federal regulators, and vendor coding resources • Mentor internal staff based on audit findings and provide education on ICD coding • Conduct process audits for compliance with internal policies, procedures, CMS regulations, OIG guidance, and other regulatory requirements • Work independently and collaboratively across cross-functional teams • Meet stringent timelines and project deadlines • Identify and communicate documentation deficiencies to support peer education and development • Maintain compliance and establish medical necessity

🎯 Requirements

• CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) certification required • Minimum of 3 years of recent, related experience in medical record documentation review, diagnosis coding, and/or auditing • Completion of an AAPC or AHIMA training program for a core credential (CPC or CCS-P), with associated work history and on-the-job experience equivalent to approximately 3 years for CPC certification • CRC (Certified Risk Adjustment Coder) required within the first six months • Associate degree, or equivalent experience preferred • Knowledge of coding guidelines and regulations • Knowledge of medical documentation requirements, fraud and abuse regulations, and penalties associated with documentation and coding violations

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility