Data Quality Auditor, Analyst

Job not on LinkedIn

🔥 0 minutes ago

🏈 Alabama, Florida, +4 more states – Remote

🏈 Alabama – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌪️ Kansas – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $21 - $44 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 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 quality inter-rater review audits of medical records coded by internal teams • Ensure ICD-10 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 audit evidence to clinical and coding staff, federal regulators and vendor coding resources • Lead dispute resolution • Mentor and educate internal staff based on audit findings, including general ICD code education • Communicate audit processes and results to departments and management • Conduct process audits for compliance with internal policies, procedures and CMS, OIG and other regulatory guidance • Identify and recommend process improvements to achieve productivity, quality, efficiency and accuracy goals • Collaborate cross-functionally on best practices • Meet project deadlines and coding accuracy and production standards • Monitor own work to ensure quality • Act ethically while handling patient data under HIPAA requirements • Serve as training resource and subject matter expert for vendors, providers and team members regarding ICD coding and documentation requirements • Assign accurate diagnosis codes based on physician and qualified healthcare provider documentation • Identify and communicate documentation deficiencies for provider, vendor and peer education • Perform other related duties as required

🎯 Requirements

• Computer proficiency including Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook) and industry standard coding applications • Experience with International Classification of Disease (ICD) codes • Minimum of 5 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing • Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) • CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment Coder) required • CPMA, CDEO or CPC-I preferred • Excellent analytical and problem solving skills • Superior communication, organizational, and interpersonal skills • BA/BS or equivalent experience • Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on-the-job experience equal to approximately 3 years for CPC • 5–8 years encompassing additional credentials and/or application of credentials • Knowledge of ICD coding, CMS documentation requirements, and State and Federal regulations • Medical record auditing skills and abstraction expertise • Knowledge of medical terminology and anatomy for all body systems • Understanding of risk adjustment audit processes • Knowledge of medical documentation, fraud, abuse and penalties for documentation and coding violations • Ability to apply AHA Coding Clinic guidance • Ability to handle patient data in compliance with HIPAA Privacy and Security rules

🏖️ 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 supporting physical, emotional, and financial well-being, based on eligibility