{"id":2993207,"url":"https://alion.io/job/cvs-health-coding-data-quality-auditor","title":"Coding Data Quality Auditor","company":{"id":4223,"name":"CVS Health","domain":"cvshealth.com","url":"https://alion.io/company/cvshealth","size_band":"5000+","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workday","truth_index":null},"role":"Finance","role_family":"Finance","seniority":"junior","employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"board_field","remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["New York, United States","Washington, United States","United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":null,"salary_estimate":{"min_usd":44000,"max_usd":88000,"period":"year","method":"role_seniority_country_remote_cell","sample_n":258},"experience_years_min":1,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"HIPAA","optional":false},{"name":"Microsoft Office","optional":false},{"name":"Outlook","optional":false}],"status":"closed","first_seen_at":"2026-10-19T00:00:00Z","employer_posted_date":"2026-10-19","last_verified_at":"2026-10-22T19:46:22Z","board_verified":false,"closed_at":"2026-10-22T19:46:22Z","days_open":3,"trust":{"level":"not_scored","repost_count":null,"flags":[],"days_open":3},"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 the audit and abstraction of provider and/or vendor medical records to identify ICD codes submitted to the Centers for Medicare & Medicaid Services (CMS). Validates that codes used for risk adjustment processes are accurate, appropriately documented, and compliant with applicable State and Federal regulations and organizational policies and procedures.\nProven ability to support coding judgment and decisions using industry standard evidence and tools.\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. \nSound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity. \nIdentify clinically active vs. historical conditions.\nDiagnosis codes must be appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.\nUtilize medical records to ensure support is documented for etiology and manifestations of disease processes. \nAdhere to stringent timelines consistent with project deadlines and directives.\nConducts self- process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body.\nRequired to act in ethical manner at all times as required under HIPAA's Privacy and Security rules to handle patient data with uncompromised adherence to the law.\nIn depth knowledge of medical terminology and anatomy for all body systems.-Understand the audit process for risk adjustment models.\nPerforms other related duties as required.\nRequired Qualifications\nCPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician).\nComputer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications).\nCapable of making outbound phone calls and faxes to providers for record retrieval and provider communications regarding audits.\nExperience with International Classification of Disease (ICD) codes required.\nMinimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing. \nPreferred Qualifications\n3 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.\nExperience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories CRC (HCC)CPMA (Certified Professional Medical Auditor), CDEO (Certified Documentation Expert Outpatient) or CPC-I (Certified Professional Coding Instructor) preferred.\nExcellent analytical and problem solving skills. Superior communication, organizational, and interpersonal skills.\nEducation\nAA/AS or equivalent experience\nCompletion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on the job experience equal to approximately 1-2 years for CPC.\nAnticipated Weekly Hours\n40Time Type\nFull timePay Range\nThe typical pay range for this role is:\n$18.50 - $38.82This 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.Additional details about available benefits are provided during the application process and on Benefits Moments.\nWe anticipate the application window for this opening will close on: 11/09/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.","description_format":"text","description_chars":5135,"description_truncated":false,"requirements":{"experience_years_min":1,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":null,"security_clearance":false,"languages":[]},"benefits":["Wellness"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Primary Care & Medical Centers","Pharmacies","Health Insurance & Benefits"],"lifecycle":[{"event":"open","at":"2026-10-21T10:31:43Z"},{"event":"close","at":"2026-10-22T19:46:22Z"}],"visa":[],"liveness":null,"pay":null,"html_url":"https://alion.io/job/cvs-health-coding-data-quality-auditor","json_url":"https://alion.io/job/cvs-health-coding-data-quality-auditor.json","meta":{"generated_at":"2026-10-23T21:53:35Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":4289,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-24T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":4223},"rest":"https://alion.io/mcp/rest/get_company?id=4223"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fcvs-health-coding-data-quality-auditor"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fcvs-health-coding-data-quality-auditor"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fcvs-health-coding-data-quality-auditor"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/cvs-health-coding-data-quality-auditor\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fcvs-health-coding-data-quality-auditor"}]}