Data Quality Auditor

Job not on LinkedIn

🔥 11 minutes ago

🏈 Alabama, Arizona, +42 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – 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 ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $18 - $38 / hour

⏰ Full Time

🟢 Junior

🔎 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

• Audit and abstract provider and/or vendor medical records to identify ICD codes submitted to CMS • Validate risk-adjustment codes for accuracy, documentation, and compliance with State and Federal regulations and organizational policies • Support coding judgments and decisions using industry-standard evidence and tools • Abstract and assign accurate medical codes for diagnoses documented by physicians and other qualified healthcare providers • Apply coding guidelines and regulations, including medical-necessity requirements • Identify clinically active versus historical conditions • Verify diagnosis codes are appropriate, accurate, and supported by clinical documentation • Use medical records to confirm documentation supports disease etiology and manifestations • Meet project deadlines and assigned timelines • Conduct self-process audits for compliance with internal policies and regulatory guidance from CMS, OIG, and other regulatory bodies • Handle patient data ethically and in accordance with HIPAA requirements • Perform other related duties as required

🎯 Requirements

• CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) • Computer proficiency, including Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook) and industry standard coding applications • Ability to make outbound phone calls and faxes to providers • Experience with International Classification of Disease (ICD) codes • Minimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing • AA/AS or equivalent experience • Completion of an AAPC/AHIMA training program for a core credential (CPC, CCS-P) with associated work history/on-the-job experience equal to approximately 1–2 years for CPC • Knowledge of medical terminology and anatomy for all body systems • Understanding of the audit process for risk adjustment models • Ability to comply with HIPAA Privacy and Security rules and applicable regulations • Preferred: 3 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing • Preferred: Experience with Medicare, Commercial, and/or Medicaid Risk Adjustment processes and Hierarchical Condition Categories • Preferred: CPMA, CDEO, or CPC-I certification • Preferred: Excellent analytical, problem-solving, communication, organizational, and interpersonal skills

🏖️ 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