At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
How will this role have an impact?
Under the supervision of the Sr. Coding Manager, this position is responsible for ICD-10 coding of health risk evaluations of Medicare and Medicaid members that are performed by the Company, and reviewing the coding of health risk evaluations, coded both internally and externally, to insure completeness, accuracy and compliance with CMS guidelines. In addition, the Coding Auditor audits Coding Specialists’ coding work output.
Essential Job Responsibilities:
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Reviews health risk evaluations within required timelines to determine completion and compliance with CMS guidelines
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Reviews and assesses the accuracy, completeness, specificity and appropriateness of diagnosis codes identified in the health risk evaluations
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Reviews health risk assessments/evaluations to accurately and completely assign all ICD-10 codes that are clinically identified and supported in the assessment/evaluation on a timely basis.
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Communicates timely and effectively with the Director of Coding, Coding Coordinators and Group Leaders regarding issues or corrections with the health risk evaluations.
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Understands the relationship between ICD-10-CM coding and HCC (hierarchical condition categories) coding
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Utilizes advanced, specialized knowledge of medical codes and coding protocol by collaborating with the Director of Coding and coding staff to ensure the organization is following Medicare coding protocol for payment of claims.
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Demonstrates a commitment to integrating coding compliance standards into coding practices .
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Identifies, corrects and reports coding problems
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Maintains adequate knowledge of coding, compliance and reimbursement procedures related to Medicare risk adjustment
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Makes recommendations for coding policy/changes
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Maintains coding certification after achieving certification status.
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Completes special projects as assigned by the Director of Coding or designee which require defining problems and implementing required changes.
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Follows all legal and policy requirements for HIPAA protected data.
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Actively demonstrates teamwork at all times.
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Strong familiarity with the Coding Clinic.
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Is able to index conditions accurately and appropriately
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Must meet and maintain productivity and accuracy targets.
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Expert level understanding of coding guidelines and is able to use and apply appropriate judgement.
Experience Requirements:
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Minimum 4 years of coding audit experience
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Minimum 6 year ICD-10 coding experience.
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Prior work experience in the healthcare field specifically related to coding is preferred.
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Experience and knowledge of Medicare HCC coding
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Experience with medical record documentation.
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Prior medical chart auditing/quality experience required.
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Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.
Essential skills and certificates:
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Certified Coding Associate ( CCA ), Certified Coding Specialist ( CCS), Certified Coding Specialist for provides ( CCS-P) or Certified Professional Coder ( CPC)
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CRC required
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ICD-10 Coding Certification
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Credentials of at least 6 years by AHIMA or AAPC required. Credentials must be current and maintained during emoployment.
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Current coding certificate in a good standing.
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Knowledge of CMS RADV protocols
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High school diploma or equivalent. Associate's or Bachelor Degree proffered.
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Basic skills in MS Office
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Basic analytical skills
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Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology
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Knowledge of CMS medical record and ICD-10 coding guidelines
About Us:
As Signifiers, we are the heart of our culture. We define and build it -- from how we treat each other, to responding to our members’ needs and serving our communities. Living our Heart At Work Behaviors™ in every interaction every day helps us to put our purpose into action for our customers and members and create a workplace where we can all thrive. Every Signifier plays an important role in creating the culture we need, want, and deserve. We do this by putting people first, joining forces, creating simplicity, championing safety and quality, rising to the challenge, and inspiring trust. Join our team and bring your heart to work as we innovate and deliver solutions to make healthcare more personal, convenient and affordable.
Signify Health, A CVS Health company, provides value-based care, reduces costs and improves outcomes for older adults. Our network of more than 12,000 clinicians across 50 states provides health risk assessments to health plan members. This brings clinicians into patients’ homes to identify chronic conditions, help bridge gaps in care, address social and behavioral risk factors on health and improve members' engagement.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$21.10 - $40.90
This 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
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Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
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No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
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Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 07/17/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Top Skills
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.
