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 SummaryResponsible for the audit and abstraction of provider and/or vendor medical records to identify ICD codes submitted to the Centers for Medicare & Medicaid Services (CMS). Validates that codes used for risk adjustment processes are accurate, appropriately documented, and compliant with applicable State and Federal regulations and organizational policies and procedures.
- Proven ability to support coding judgment and decisions using industry standard evidence and tools.
- Proficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other qualified healthcare providers in the office and/or facility setting.
- Sound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity.
- Identify clinically active vs. historical conditions.
- Diagnosis codes must be appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.
- Utilize medical records to ensure support is documented for etiology and manifestations of disease processes.
- Adhere to stringent timelines consistent with project deadlines and directives.
- Conducts self- process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body.
- Required to act in ethical manner at all times as required under HIPAA's Privacy and Security rules to handle patient data with uncompromised adherence to the law.
- In depth knowledge of medical terminology and anatomy for all body systems.-Understand the audit process for risk adjustment models.
- Performs other related duties as required.
Required Qualifications
- CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician).
- Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications).
- Capable of making outbound phone calls and faxes to providers for record retrieval and provider communications regarding audits.
- Experience with International Classification of Disease (ICD) codes required.
- Minimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
Preferred Qualifications
- 3 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
- Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories CRC (HCC)CPMA (Certified Professional Medical Auditor), CDEO (Certified Documentation Expert Outpatient) or CPC-I (Certified Professional Coding Instructor) preferred.
- Excellent analytical and problem solving skills. Superior communication, organizational, and interpersonal skills.
Education
- 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.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 - $38.82This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) certification
- Computer proficiency, including Microsoft Office products and industry-standard coding applications
- Ability to make outbound phone calls and send faxes to providers for record retrieval and audit communications
- Experience with International Classification of Diseases (ICD) codes
- At least 1 year of recent, related experience in medical record documentation review, diagnosis coding, and/or auditing
- Associate of Arts or Associate of Science degree, or equivalent experience
- Completion of an AAPC or AHIMA training program for a core credential with approximately 1–2 years of related work experience
- 3 years of recent, related experience in medical record documentation review, diagnosis coding, and/or auditing
- Experience with Medicare, Commercial, or Medicaid risk adjustment processes and Hierarchical Condition Categories
- CPMA, CDEO, or CPC-I certification
- Excellent analytical, problem-solving, communication, organizational, and interpersonal skills
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
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Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
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Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
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What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
