{"schemaVersion":"jobsearcher.job.v1","id":"a11ee7daaae8b3c8bd9eb948","url":"https://jobsearcher.com/jobs/a11ee7daaae8b3c8bd9eb948","canonicalUrl":"https://jobsearcher.com/jobs/a11ee7daaae8b3c8bd9eb948","title":"Coding Data Quality Auditor","description":"We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.\nPosition Summary\nResponsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit 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 all State and Federal regulations and internal policies and procedures.\n\nProven ability to support coding judgment and decisions using industry standard evidence and tools.\n\nProficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other qualified healthcare providers in the office and/or facility setting.\n\nSound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity.\n\nIdentify clinically active vs. historical conditions.\n\nDiagnosis codes must be appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.\n\nUtilize medical records to ensure support is documented for etiology and manifestations of disease processes.\n\nAdhere to stringent timelines consistent with project deadlines and directives.\n\nConducts self- process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body.\n\nRequired Qualifications\n\nMinimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.\n\nCPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required.\n\nComputer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications).\n\nExperience with International Classification of Disease (ICD) codes required.\n\nPreferred Qualifications\n\nCRC (Certified Risk Adjustment Coder)\n\nExperience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred.\n\nEducation\n\nAA/AS or equivalent experience\n\nCompletion 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.\n\nAnticipated Weekly Hours\n40\nTime Type\nFull time\nPay Range\nThe typical pay range for this role is\n$18.50 - $38.82\nThis pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.\nOur 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.\nGreat benefits for great people\nWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.\nThis full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.\nAdditional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .\nWe anticipate the application window for this opening will close on: 05/05/2026\nQualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.\nCVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.","company":"CVS Health","rawCompany":"cvs health","city":"Woonsocket","state":"RI","isRemote":false,"isActive":false,"createdAt":"2026-04-23T04:05:48.936Z","occupations":[{"code":"29-9021.00","title":"Health Information Technologists and Medical Registrars","slug":"health-information-technologists-and-medical-registrars"},{"code":"29-2072.00","title":"Medical Records Specialists","slug":"medical-records-specialists"},{"code":"29-1299.00","title":"Healthcare Diagnosing or Treating Practitioners, All Other","slug":"healthcare-diagnosing-or-treating-practitioners-all-other"}],"industries":[{"code":"621999","title":"All Other Miscellaneous Ambulatory Health Care Services","slug":"all-other-miscellaneous-ambulatory-health-care-services"},{"code":"622110","title":"General Medical and Surgical Hospitals","slug":"general-medical-and-surgical-hospitals"},{"code":"621111","title":"Offices of Physicians (except Mental Health Specialists)","slug":"offices-of-physicians-except-mental-health-specialists"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"Coding Data Quality Auditor","description":"We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.\nPosition Summary\nResponsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit 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 all State and Federal regulations and internal policies and procedures.\n\nProven ability to support coding judgment and decisions using industry standard evidence and tools.\n\nProficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other qualified healthcare providers in the office and/or facility setting.\n\nSound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity.\n\nIdentify clinically active vs. historical conditions.\n\nDiagnosis codes must be appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.\n\nUtilize medical records to ensure support is documented for etiology and manifestations of disease processes.\n\nAdhere to stringent timelines consistent with project deadlines and directives.\n\nConducts self- process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body.\n\nRequired Qualifications\n\nMinimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.\n\nCPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required.\n\nComputer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications).\n\nExperience with International Classification of Disease (ICD) codes required.\n\nPreferred Qualifications\n\nCRC (Certified Risk Adjustment Coder)\n\nExperience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred.\n\nEducation\n\nAA/AS or equivalent experience\n\nCompletion 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.\n\nAnticipated Weekly Hours\n40\nTime Type\nFull time\nPay Range\nThe typical pay range for this role is\n$18.50 - $38.82\nThis pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.\nOur 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.\nGreat benefits for great people\nWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.\nThis full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.\nAdditional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .\nWe anticipate the application window for this opening will close on: 05/05/2026\nQualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.\nCVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.","datePosted":"2026-04-23T04:05:48.936Z","dateModified":"2026-04-23T04:05:48.936Z","hiringOrganization":{"@type":"Organization","name":"CVS Health","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Woonsocket","addressRegion":"RI","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"a11ee7daaae8b3c8bd9eb948"},"url":"https://jobsearcher.com/jobs/a11ee7daaae8b3c8bd9eb948"}}