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# Coding Data Quality Auditor

- **Company:** CVS Health
- **Location:** Nashville, TN, United States
- **Salary:** $38,480.0 - $80,746.0
- **Contract:** Permanent contract
- **Skills:** Adobe Analytics, Microsoft Access, Microsoft Word, Microsoft Excel, Microsoft Outlook, Computer Literacy, Document Retrieval, Microsoft Office, Microsoft PowerPoint
- **Published:** October 17, 2026
- **Apply:** https://www.nashvillejobsite.com/job.asp?id=3454774917&tx=KR8181FFQ&pt=1&aff=0B19D771-A501-4A5E-8338-2A822B784D54&utm_source=Job%20Feed&utm_medium=textkernel&utm_campaign=DE&utm_term=0B19D771-A501-4A5E-8338-2A822B784D54

## About the Role

* 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., * 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.

## Description

Responsible 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.