Coding Data Quality Auditor at CVS Health

Remote | Full-time
CVS Health

Title: Coding Data Quality Auditor

Location: WORK FROM HOME USA
Category: Aetna
Job Type: Fully remote
Job Description: Job Description
*This is a Full-time Telework Opportunity anywhere in the US

Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes. Diagnosis codes must be appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures. Ability to support coding judgment and decisions using industry standard evidence and tools. Assists senior level staff in providing recommendations for process improvement so that productivity and quality goals can be met or exceeded and operational efficiency and financial accuracy can be achieved. Adhere to stringent timelines consistent with project deadlines and directives. Must possess high level of dependability and ability to meet coding accuracy and production standards. Monitors own work to help ensure quality. Required to act in ethical manner at all times as required under HIPAA’s Privacy and Security rules to handle patient data with uncompromised adherence to the law.

Required Qualifications

  • Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications).
  • Experience with International Classification of Disease (ICD) codes required Minimum of 3 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
  • CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required.
  • Excellent analytical and problem-solving skills
  • Demonstrated communication, organizational, and interpersonal skills.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

  • Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred.
  • CRC (Certified Risk Adjustment Coder) preferred.

Education

  • AA/AS 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.

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