About CVS Health
At CVS Health, we’re transforming health care with purpose and compassion. As the nation’s leading health solutions company, we serve millions of Americans through a powerful combination of local presence, digital innovation, and more than 300,000 colleagues who care deeply about improving lives.
We are seeking a Risk Adjustment Auditor to join our team and ensure accuracy, compliance, and integrity in medical record coding and documentation.
What You’ll Do
- Conduct audits, reviews, and assessments of medical records coded by internal teams prior to CMS submission.
- Ensure risk adjustment processes are accurate, clinically supported, and fully compliant with state, federal, and internal guidelines.
- Deliver compliance reporting and documentation, highlighting key findings and recommendations.
- Mentor peers and serve as a subject matter expert in ICD coding and documentation requirements.
- Support training for vendors, providers, and team members on compliance, documentation, and coding best practices.
- Identify documentation deficiencies and create opportunities for continuous education.
- Apply expert knowledge of fraud, abuse, penalties, and regulatory requirements.
Required Qualifications
- 5+ years of recent experience in medical record documentation review, diagnosis coding, and/or auditing.
- Proven expertise with Medicare/Commercial/Medicaid Risk Adjustment and Hierarchical Condition Categories (HCC).
- Certifications required:
- CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist – Physician)
- CRC (Certified Risk Adjustment Coder)
- Strong knowledge of ICD codes and risk adjustment regulations.
Preferred Qualifications
- CPMA (Certified Professional Medical Auditor) or CDEO (Certified Documentation Expert Outpatient).
- Bachelor’s degree or equivalent work experience.
- Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, Access, Outlook) and industry-standard coding tools.
- Excellent problem-solving, decision-making, and communication skills.
Why CVS Health
We believe our colleagues fuel our future. That’s why we provide a comprehensive and competitive benefits package, including:
- Affordable medical plan options.
- 401(k) with company match and employee stock purchase plan.
- Paid time off, flexible work schedules, family leave, and dependent care resources.
- No-cost wellness programs, confidential counseling, and financial coaching.
- Tuition assistance and retiree medical access.
For more details, visit CVS Health Benefits.
Application Deadline: October 13, 2025
CVS Health is an equal opportunity employer. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.
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