• The Attorney Auditor reviews legal and non-legal invoices on behalf of our clients for services provided to insurance carriers, corporate legal departments and government entities. • The auditor will apply client specified billing guidelines and/or Generally Accepted Principles and Standards (“GAPS”).

• This role is part of the training team for the Clinical Chart Validation team. • This position is responsible for improving the technical effectiveness of our teams by planning, developing, and delivering technical training, mentoring, and assessment. • The individual will work collaboratively with subject matter experts in the Commercial & Government Audit Teams, Quality Assurance, Concept Development, and others to validate workflows and communication tools to enhance audit productivity, performance, and client satisfaction. • Assess job-specific needs and develop technical training plans with clear business objectives, including working with subject matter experts, developing training materials, and developing appropriate assessments and measurements of success. • Select training/instructional methods and procedures appropriate for the situation when learning or teaching new skills. • Deliver specific training sessions, including using suitable delivery methods such as classroom, online, and webinar. • Identify the development needs of others and coach, mentor, or otherwise assist others with improving their knowledge skills. • Provide support to the CCV audit team members; assist with orientation of new members as needed, mentor new team members after orientation. • Promote audit accuracy measures by training/educating and mentoring the auditor and providing documented and validated findings. • Encourage critical thinking and discussion among team members on concepts as needed. • Provide training on one or more of the following audit types: Outpatient and Specialty Review Types to include SNF, IRF, and HH. • Train Clinicians with coding certifications on coding principles. • Confer with management and conduct surveys to identify training needs based on projected production processes, changes, and other factors. • Participate in weekly/monthly team meetings to share best practices initiatives and recommend audit vulnerabilities. • Support the Medical Director to ensure accurate assessments of improper payments are based on consistent application of clinical guidelines. • Assess customer/provider/stakeholder issues, complaints, and compliments. • Monitor/Assess the performance of self, other individuals, &/or organizations to make improvements or recommend remediation or corrective action. • Work with the Quality Team to train audit team members on findings from quality review audits. • Develop testing and evaluation procedures. • Evaluate instructor performance and the effectiveness of training programs, providing recommendations for improvements. • Conduct or arrange for ongoing technical training and personal development classes for staff members. • Integrate healthcare auditing principles and use objectivity in the performance of medical audit activities and reviews. • Draw on healthcare proficiency and industry knowledge to substantiate conclusions. • Perform work independently, review and interpret audit work of others. Depending on the nature and scope of the audit, may review medical records and apply in-depth knowledge of clinical criteria to determine medical necessity, appropriateness of setting, potential billing/coding issues, and quality concerns. • Demonstrate an understanding of complex contract specifications when performing medical record reviews. • Use healthcare expertise to determine approval or referral to the Medical Director. • Provide feedback on reviews to the Quality Assurance Manager as indicated in order to assist with the improvement of rationales sent to providers. • Develop reasonable and effective recommendations for concept solutions that reflect an understanding of the client environment and risks inherent to our business and industry. • Suggest and or develop and implement new ideas, approaches, decision trees, and/or technological improvements that will support and optimize audit results. • Collaborate with Data Services in developing new reports. • In addition to regular and predictable attendance, maintain production goals and quality standards set by the audit. • Performs QA audits against the expected level of quality and quantity (i.e. hit rate, # claims written, ID per hour).

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 Summary Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal 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 Qualifications - Minimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing. - CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required. - Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications Preferred Qualifications - 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. - Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories Education - AA/AS or equivalent experience Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $18.50 - $38.82 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 04/14/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

• Performs periodic and ongoing audits of claims to ensure accuracy of coding and billing, and sufficiency of supporting documentation. • Audits specified number of records per coder as defined in the system coding audit plan. • Prepares audit reports that are issued to key stakeholders, as appropriate. • Develops corrective action plans to address opportunities for coding, billing and documentation improvement. • Identifies trends and educational opportunities. • Prepares and presents educational programs related to coding. • Assists in the management of the coding and billing auditing and monitoring program to address high risk compliance areas. • Performs other duties as assigned.