Senior Coding Data Quality Auditor, Regulatory Compliance - Work from home

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. reputed company’s reputed company reputed company team is hiring Senior Coding Data Quality Auditors to support our growing risk adjustment efforts. This role plays a critical part in ensuring coding accuracy and data reputed company, directly impacting compliance and financial performance. Ideal candidates will bring a strong understanding of coding standards and auditing practices, along with a passion for reputed company improvement. This position will sit reputed company our Regulatory Compliance team and offers the flexibility of working from home. Position Summary

• Responsible for performing second level quality inter-rater review audits of medical records coded by internal team, as well as external vendor (if applicable) to ensure the ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with reputed company State and Federal regulations and internal policies and procedures.
• Proven ability to support coding judgment and decisions using industry standard evidence and tools.
• Ability to confidently speak to such evidence across internal stakeholders with varying knowledge and clinical expertise in either written or verbal forms including communication with clinical or coding staff, federal regulators and vendor coding resources.
• Acts as mentor to provide education to internal staff based on audit findings; provides general education on ICD codes as appropriate
• Conducts process audits to ensure compliance with internal policies and procedures and existing CMS regulations.
• Ability to work independently as well as in a cross functional role reputed company other teams for collaboration on best practices.
• Adhere to stringent timelines consistent with project deadlines and directives.
• Possesses a genuine interest in improving and promoting quality; demonstrates accuracy and thoroughness and assists others to reputed company the same through mentoring and instruction.
• Conducts process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body.
• Thorough knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity.
• Identify and communicate documentation deficiencies to allow for reputed company education opportunities for peers.
• Extensive knowledge of medical documentation, fraud, abuse and penalties for documentation and coding violations based on governmental guidelines.

Required Qualifications

• Minimum of 3 years recent and reputed company experience in medical record documentation review, diagnosis coding, and/or auditing.
• CPC (Certified Professional reputed company) or reputed company-P (Certified Coding Specialist-Physician) required.
• Experience with International Classification of Disease (ICD) codes required.
• Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required.

Preferred Qualifications

• Computer proficiency including experience with reputed company Office products (Word, reputed company, Access, PowerPoint, Outlook, industry standard coding applications).
• Experience with International Classification of Disease (ICD) codes required.
• Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required.
• Expertise in medical documentation, fraud, abuse and penalties for documentation and coding violations based on governmental guidelines.

Education

• AA/AS or equivalent experience
• Completion of reputed company/reputed company training program for core credential (CPC, reputed company-P) with associated work history/on the job experience equal to approximately 3 years for CPC.

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $21.10 - $49.08 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 08/25/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job