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Data Quality Audit Analyst
CVS HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in ICD Coding, medical record documentation review, and compliance with CMS regulations. Proficient in mentoring staff and conducting audits to ensure accuracy and adherence to coding guidelines.
Highest-signal resume keywords
CPC CertificationCCS-P CertificationCRC CertificationMedical Record Documentation ReviewICD Coding
About the role
Key responsibilities & impact- Perform second-level quality inter-rater review audits of medical records coded by internal teams and external vendors, when applicable
- Ensure ICD codes submitted to CMS for risk adjustment are appropriate, accurate, and supported by clinical documentation
- Support coding judgments and decisions using industry-standard evidence and tools
- Communicate supporting evidence to internal stakeholders, clinical staff, coding staff, federal regulators, and vendor coding resources
- Mentor internal staff based on audit findings and provide education on ICD coding
- Conduct process audits for compliance with internal policies, procedures, CMS regulations, OIG guidance, and other regulatory requirements
- Work independently and collaboratively across cross-functional teams
- Meet stringent timelines and project deadlines
- Identify and communicate documentation deficiencies to support peer education and development
- Maintain compliance and establish medical necessity
Requirements
What you’ll need- CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) certification required
- Minimum of 3 years of recent, related experience in medical record documentation review, diagnosis coding, and/or auditing
- Completion of an AAPC or AHIMA training program for a core credential (CPC or CCS-P), with associated work history and on-the-job experience equivalent to approximately 3 years for CPC certification
- CRC (Certified Risk Adjustment Coder) required within the first six months
- Associate degree, or equivalent experience preferred
- Knowledge of coding guidelines and regulations
- Knowledge of medical documentation requirements, fraud and abuse regulations, and penalties associated with documentation and coding violations
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Diagnosis CodingQuality AuditingCoding Guidelines KnowledgeRegulatory ComplianceDocumentation ReviewClinical DocumentationEvidence-Based SupportProcess AuditsMedical NecessityFraud and Abuse Regulations
Soft Skills
CommunicationMentoringCollaborationProblem-SolvingTime Management
Certifications & Qualifications
CPCCCS-PCRC
Industry Keywords
CMS RegulationsOIG GuidanceRisk AdjustmentInternal PoliciesClinical Staff Interaction