CVS Health

Coding Quality Auditor

Posted 18 days ago

Job Description

Job Description
Responsible for performing audits of medical records to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the Risk Adjustment Payment System (RAPS) are appropriate, accurate, and supported by written clinical documentation in accordance with all state and federal regulations and internal policies and procedures.
- Performs audits of medical records to ensure all assigned ICD-10 codes are accurate and supported by written clinical documentation.
- Provides education to internal staff and external providers based on audit findings; provides general education on ICD-10 codes as appropriate.
- Effectively communicates the audit process and results to the appropriate departments and management.
- 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.
- Maintains current knowledge of ICD-10 codes, CMS documentation requirements, and state and federal regulations.
- Performs other related duties as required.

Required Qualifications
Required Qualifications :
- Experience with Microsoft Office products (Word, Excel, Project, PowerPoint, Outlook).
- Experience with ICD-10 codes required.
- Experience with Medicare and/or Medicaid Risk Adjustment process required
- CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician).
- Required Minimum of 2 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
- Excellent analytical and problem solving skills Effective communications, organizational, and interpersonal skills.
- High School Diploma or G.E.D.

Preferred Qualifications
Please review required qualifications above

High School diploma, G.E.D. or equivalent experience

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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