Data Quality Auditor, Coding Analyst

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🔥 0 minutes ago

🏈 Alabama, Florida, +2 more states – Remote

🏈 Alabama – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌪️ Kansas – Remote

💵 $21 - $44 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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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 the internal team • 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 coding evidence to clinical staff, coding staff, federal regulators, and vendor coding resources • Lead dispute resolution • Mentor and educate internal staff based on audit findings • Communicate audit processes and results to departments and management • Conduct process audits for compliance with internal policies, procedures, and CMS regulations • Identify and recommend process improvements to achieve productivity, quality, efficiency, and accuracy goals • Collaborate cross-functionally on best practices • Meet project timelines and coding accuracy and production standards • Handle patient data ethically in accordance with HIPAA Privacy and Security rules • Serve as a training resource and subject matter expert for vendors, providers, and team members on ICD coding and documentation requirements • Assign accurate diagnosis codes based on physician and qualified healthcare provider documentation • Apply coding guidelines, regulations, and AHA Coding Clinic guidance to resolve coding issues • Identify and communicate documentation deficiencies for continuous 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 Diseases (ICD) codes • Minimum of 5 years of recent related experience in medical record documentation review, diagnosis coding, and/or auditing • Experience with Medicare, Commercial, and/or Medicaid risk adjustment processes and Hierarchical Condition Categories (HCC) • CPC or CCS-P and CRC certifications required • CPMA, CDEO, or CPC-I preferred • Excellent analytical and problem-solving skills • Superior communication, organizational, and interpersonal skills • Completion of an AAPC/AHIMA training program for a core credential, with associated work history/on-the-job experience • BA/BS or equivalent experience • Knowledge of medical terminology and anatomy for all body systems • Knowledge of coding guidelines and regulations, including medical necessity • Knowledge of risk adjustment audit processes • Knowledge of medical documentation, fraud, abuse, and penalties for documentation and coding violations • Current educational training in ICD coding, CMS documentation requirements, and State and Federal regulations • Ability to work independently and cross-functionally • Ability to meet stringent project deadlines and coding accuracy and production standards • Ethical handling of patient data in compliance with HIPAA Privacy and Security rules

🏖️ Benefits

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