Analyst, Coding Data Quality Audit

About this role

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.


Position Summary
The Coding Data Quality Audit Analyst is responsible for performing second-level quality inter-rater review audits of medical records coded by internal teams, as well as external vendors (if applicable), to ensure that ICD codes submitted to the Centers for Medicare & Medicaid Services (CMS) for risk adjustment purposes are appropriate, accurate, and supported by clinical documentation in accordance with all state and federal regulations, as well as internal policies and procedures.


Job Responsibilities

• Demonstrates the ability to support coding judgments and decisions using industry-standard evidence and tools.
• Confidently communicates supporting evidence to internal stakeholders with varying levels of coding and clinical expertise through both written and verbal communication, including interactions with clinical staff, coding staff, federal regulators, and vendor coding resources.
• Acts as a mentor by providing education to internal staff based on audit findings and offers general education on ICD coding, as appropriate.
• Conducts process audits to ensure compliance with internal policies, procedures, CMS regulations, and guidance from the Office of Inspector General (OIG) and other regulatory bodies.
• Demonstrates the ability to work independently and collaboratively across cross-functional teams to promote best practices.
• Adheres to stringent timelines and project deadlines.
• Demonstrates a genuine commitment to quality improvement, accuracy, and thoroughness while assisting othe...