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Data Quality Auditor
CVS HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical record auditing and coding, with a strong focus on accurate ICD code assignment and compliance with regulatory guidelines. Proficient in utilizing coding tools and maintaining documentation standards to support risk adjustment processes.
Highest-signal resume keywords
ICD Code AssignmentMedical Record AuditingCPC CertificationRisk Adjustment ProcessesMicrosoft Office Proficiency
About the role
Key responsibilities & impact- Perform audit and abstraction of medical records from providers and/or vendors
- Identify and submit appropriate, accurate, and clinically supported ICD codes to CMS for risk adjustment processes
- Support coding judgments and decisions using industry-standard evidence and tools
- Abstract and assign accurate medical codes for diagnoses documented by physicians and other qualified healthcare providers in office and/or facility settings
- Apply coding guidelines and regulations, including requirements for establishing medical necessity
- Identify clinically active versus historical conditions
- Use medical records to verify documentation supporting disease etiology and manifestations
- Meet stringent timelines aligned with project deadlines and directives
- Conduct self-process audits for compliance with internal policies, procedures, and regulatory guidance from CMS, OIG, and other regulatory bodies
Requirements
What you’ll need- Minimum of 1 year 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
- Computer proficiency including Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, and industry standard coding applications)
- Experience with International Classification of Disease (ICD) codes required
- CRC (Certified Risk Adjustment Coder) preferred
- Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred
- 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 1–2 years for CPC
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay range
- 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
Medical CodingDiagnosis CodingAbstraction of Medical RecordsCoding Guidelines ApplicationCompliance AuditingDocumentation ReviewDisease Etiology VerificationClinical Coding JudgmentsTimeliness in Project DeadlinesHierarchical Condition Categories (HCC)
Soft Skills
Attention to DetailAnalytical ThinkingTime ManagementCommunication SkillsProblem-Solving
Tools & Technologies
Microsoft WordMicrosoft ExcelMicrosoft AccessMicrosoft PowerPointMicrosoft OutlookIndustry Standard Coding Applications
Certifications & Qualifications
CPC (Certified Professional Coder)CCS-P (Certified Coding Specialist-Physician)CRC (Certified Risk Adjustment Coder)
Industry Keywords
CMS RegulationsOIG ComplianceMedicare Risk AdjustmentMedicaid Risk AdjustmentCommercial Risk AdjustmentAAPC TrainingAHIMA Training