Data Quality Auditor

CVS Health

. Audit and abstract provider and/or vendor medical records to identify ICD codes submitted to CMS .

Posted 10/14/2026full-timeRemote • United StatesJunior💰 $19 - $39 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical coding, including ICD code assignment and compliance with CMS regulations. Proficient in auditing medical records and ensuring documentation accuracy while adhering to HIPAA requirements.

Highest-signal resume keywords

CPC CertificationICD Code ExperienceMedical Record Documentation ReviewRisk Adjustment AuditingHIPAA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical CodingDiagnosis CodingAudit Process UnderstandingMedical Terminology KnowledgeClinical Documentation Verification

Soft Skills

Analytical SkillsProblem-Solving SkillsCommunication SkillsOrganizational SkillsInterpersonal Skills

Tools & Technologies

Microsoft Office SuiteIndustry Standard Coding Applications

Certifications & Qualifications

CPCCCS-PCPMACDEOCPC-I

Industry Keywords

CMS RegulationsRisk Adjustment ProcessesMedicareMedicaidHierarchical Condition Categories

About the role

Key responsibilities & impact

Audit and abstract provider and/or vendor medical records to identify ICD codes submitted to CMS
Validate risk-adjustment codes for accuracy, documentation, and compliance with State and Federal regulations and organizational policies
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
Apply coding guidelines and regulations, including medical-necessity requirements
Identify clinically active versus historical conditions
Verify diagnosis codes are appropriate, accurate, and supported by clinical documentation
Use medical records to confirm documentation supports disease etiology and manifestations
Meet project deadlines and assigned timelines
Conduct self-process audits for compliance with internal policies and regulatory guidance from CMS, OIG, and other regulatory bodies
Handle patient data ethically and in accordance with HIPAA requirements
Perform other related duties as required

Requirements

What you’ll need

CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician)
Computer proficiency, including Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook) and industry standard coding applications
Ability to make outbound phone calls and faxes to providers
Experience with International Classification of Disease (ICD) codes
Minimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing
AA/AS or equivalent experience
Completion of an AAPC/AHIMA training program for a core credential (CPC, CCS-P) with associated work history/on-the-job experience equal to approximately 1–2 years for CPC
Knowledge of medical terminology and anatomy for all body systems
Understanding of the audit process for risk adjustment models
Ability to comply with HIPAA Privacy and Security rules and applicable regulations
Preferred: 3 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing
Preferred: Experience with Medicare, Commercial, and/or Medicaid Risk Adjustment processes and Hierarchical Condition Categories
Preferred: CPMA, CDEO, or CPC-I certification
Preferred: Excellent analytical, problem-solving, communication, organizational, and interpersonal skills

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