Coding Data Quality Auditor, Analyst

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 Responsible for performing quality inter-rater review audits of medical records coded by internal team (CDQA and Sr CDQA) to ensure the ICD-10 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. In this position you will have the opportunity to demonstrate proficiency in the following: Proven ability to support coding judgment and decisions using industry standard evidence and tools. Ability to confidently speak to such evidence across stakeholders with varying knowledge and clinical expertise in either written or verbal forms including communication with clinical or coding staff, federal regulators and vendor coding resources. Leads dispute resolution. Acts as mentor to provide education to internal staff based on audit findings; provides general education on ICD codes as appropriate. Effectively communicates the audit process and results to appropriate departments and management. Conducts process audits to ensure compliance with internal policies and procedures and existing CMS regulations. Identifies and recommends opportunities for process improvements so that productivity and quality goals can be met or exceeded and operational efficiency and final accuracy is achieved. Ability to work independently as well as in a cross functional role within other teams for collaboration on best p...