Senior Coding Data Quality Auditor, Coding Quality Operations - Work From Home - Remote Eligible

Senior Coding Data Quality Auditor

At CVS Health, we are 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 reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Aetna's Revenue Integrity 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 integrity, directly impacting compliance and financial performance. Ideal candidates will bring a strong understanding of coding standards and auditing practices, along with a passion for continuous improvement. This position will sit within our Coding Quality Operations team and offers the flexibility of working from home.

Position responsibilities include:

• Performing second level quality inter-rater review audits of medical records coded by internal team and external vendors.
• Providing support for coding judgment and decisions using industry standard evidence and tools.
• Acting as a mentor to provide education to internal staff based on audit findings.
• Conducting process audits to ensure compliance with internal policies and procedures and existing CMS regulations.
• Ability to work independently and in a cross functional role within other teams for collaboration on best practices.
• Adhering to stringent timelines consistent with project deadlines and directives.
• Conducting 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.
• Identifying and communicating documentation deficiencies to allow for continuous 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 related experience in medical record documentation review, diagnosis coding, and/or auditing. CPC (Certified Professional Coder) or CCS-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. CRC (Certified Risk Adjustment Coder) required within the first six months.

Preferred Qualifications

Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications). 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 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.

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 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.

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 all 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.

This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.