Lead Director, Coding Audit & Compliance

CVS Health

. Provide strategic leadership and organizational oversight for Coding Audit and Coding Compliance functions .

Posted 9/29/2026full-timeRemote • Texas • United StatesSenior💰 $100,000 - $231,540 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Coding Audit and Compliance, with a strong focus on CMS requirements, ICD-10-CM guidelines, and risk adjustment methodologies. Proven ability to lead cross-functional teams, develop strategic initiatives, and implement quality controls in coding operations.

Highest-signal resume keywords

Coding Audit Program DevelopmentMedicare Risk Adjustment ExpertiseCertified Risk Adjustment Coder (CRC)ICD-10-CM Coding Guidelines KnowledgeLeadership in Compliance and Quality Assurance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Coding Audit MethodologiesQuality Assurance ProcessesRisk Assessment TechniquesRoot-Cause AnalysisCorrective Action ProcessesCoding Compliance PrinciplesData Analysis and ReportingPolicy DevelopmentOperational Requirements InterpretationPerformance Measurement

Soft Skills

Analytical SkillsDecision-Making SkillsCommunication SkillsCollaboration SkillsLeadership Skills

Tools & Technologies

Business Intelligence ToolsAI/NLP-Assisted Coding TechnologiesQuality Analytics Software

Certifications & Qualifications

Certified Professional Coder (CPC)Certified Coding Specialist (CCS)Certified Risk Adjustment Coder (CRC)Certified Professional Medical Auditor (CPMA)Certified in Healthcare Compliance (CHC)Registered Health Information Administrator (RHIA)Registered Health Information Technician (RHIT)

Industry Keywords

CMS RequirementsICD-10-CM GuidelinesHealthcare QualityRisk AdjustmentCoding ComplianceOIG PrioritiesMedicareMedicaidHealthcare AdministrationClient Audits

About the role

Key responsibilities & impact

Provide strategic leadership and organizational oversight for Coding Audit and Coding Compliance functions
Establish and execute coding quality, audit, and compliance strategy aligned with CMS requirements, ICD-10-CM guidelines, risk adjustment requirements, internal policies, and client contractual obligations
Establish governance, audit methodologies, quality controls, coding policies, and risk-management processes across internal and external coding operations
Serve as senior coding subject matter expert and escalation point for complex coding, audit, compliance, regulatory, and client matters
Develop and oversee a comprehensive, risk-based Coding Audit Program, including methodology, sampling strategies, quality thresholds, escalation criteria, and corrective actions
Establish coding quality and compliance standards across internal and external coding resources
Identify systemic risks and direct root-cause analysis, remediation, education, and preventive action
Establish performance measures, key risk indicators, and reporting for Coding Audit and Compliance effectiveness
Ensure coding practices align with CMS guidance, federal and state requirements, internal policies, contracts, and industry standards
Develop, interpret, implement, and maintain coding policies, guidelines, audit standards, and compliance requirements
Monitor CMS risk adjustment models, coding guidance, OIG priorities, and regulatory changes
Direct readiness activities for CMS RADV, OIG reviews, client audits, internal compliance reviews, and other regulatory or contractual audits
Advise executive leadership on material coding risks and mitigation strategies
Lead client audits, coding disputes, appeals, corrective action plans, and quality or compliance escalations
Establish governance for coding audit appeals and dispute resolution
Set coding quality and audit standards for external coding vendors
Use audit results, Business Intelligence reporting, quality data, client findings, and analytics to identify trends and improvement opportunities
Translate quality and compliance data into actionable recommendations
Provide leadership for coding application, automation, and AI/NLP-assisted coding and auditing initiatives
Establish validation, quality-control, and monitoring requirements for technology-enabled processes
Develop and execute annual and multi-year strategic roadmaps
Represent Coding Audit & Compliance in cross-functional initiatives with Coding Operations, Clinical, Product, Engineering, Analytics, Client Success, Legal, Enterprise Compliance, and Vendor Management
Provide leadership, coaching, development, succession planning, and career development for Coding Audit and Compliance staff
Oversee hiring, performance management, professional development, and personnel-management activities
Promote accountability, collaboration, continuous improvement, professional judgment, quality, and compliance

Requirements

What you’ll need

Bachelor's degree in Health Information Management, Healthcare Administration, Business Administration, Health Sciences, or a related field preferred; equivalent relevant education, certification, and experience may be considered
Eight or more years of progressive experience in medical coding, coding audit, coding compliance, healthcare quality, or risk adjustment
Five or more years of progressive leadership experience within a medical coding, audit, compliance, quality, or risk adjustment environment
Experience leading managers, supervisors, team leads, or multiple functional teams strongly preferred
Experience developing or overseeing coding audit, quality assurance, compliance, or risk-management programs
Significant experience with Medicare risk adjustment, CMS requirements, coding audits, and complex quality or compliance matters
Active Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent nationally recognized coding credential
Certified Risk Adjustment Coder (CRC) required
Advanced knowledge of ICD-10-CM coding guidelines, CMS risk adjustment requirements, HCC models, medical record documentation requirements, and coding compliance principles
Advanced knowledge of coding audit methodologies, quality assurance, risk assessment, root-cause analysis, and corrective action processes
Ability to interpret complex coding and regulatory requirements and translate them into policies, controls, operational requirements, and organizational recommendations
Strong analytical and decision-making skills; ability to identify trends, assess risk, and translate complex information into actionable recommendations
Ability to lead within a matrixed organization, influence stakeholders outside direct reporting relationships, and manage complex cross-functional initiatives
Excellent written and verbal communication skills for operational, clinical, technical, client-facing, and executive audiences
Preferred: Certified Professional Medical Auditor (CPMA)
Preferred: Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT)
Preferred: Certified in Healthcare Compliance (CHC)
Preferred experience with CMS RADV, OIG risk adjustment initiatives, client coding audits, and regulatory reviews
Preferred experience with Medicare, Medicaid, and ACA risk adjustment methodologies
Preferred experience with Business Intelligence tools, coding quality analytics, and AI/NLP-assisted coding or auditing technologies

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program
Award target in the company’s equity award program
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