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Coding Data Quality Auditor
Location
United States + 1 moreAll locations: United States | United Kingdom
Posted
66 days ago
Salary
$19 - $39 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Coding Data Quality Auditor
CVS Health
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). - Experience with International Classification of Disease (ICD) codes required. Preferred Qualifications - CRC (Certified Risk Adjustment Coder) - Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred. 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 3 years for CPC. 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: 05/05/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Auditor II - Division of Gaming
State of ColoradoThe State of Colorado is located in the Rocky Mountain region of the western United States. It entered the 100-year-old Union in 1876, earning the nickname "Cen
Title: Auditor II - Division of Gaming Location: Statewide United States Job Description: This position is open only to Colorado state residents. The mission of the Colorado Department of Revenue (CDOR) is to become a trusted partner to every Coloradan to help them navigate the complexities of government so they can thrive. We are driven by our values of service, teamwork, accountability, integrity, and respect. The vision of the department is to empower businesses and individuals through quality customer service, innovation, and collaboration. We celebrate diversity and support an equitable and inclusive culture. We embrace our differences because we believe this brings innovation to our work. For more exciting information about the Department of Revenue, please enjoy this brief video! The Division of Gaming ensures that limited gaming is conducted honestly, fairly, and competitively, and is free from criminal and corrupt elements. 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To be compliant with the new fleet vehicle policy, Motor Vehicle Records (MVRs) will be pulled for review for workers who: - Have an assigned State fleet vehicle - Are required to operate a vehicle as part of the position - Utilize a State fleet vehicle as a pool vehicle Minimum Qualification Screening A Human Resources Analyst will only review the work experience/job duties sections of the online job application, to determine whether you meet the minimum qualifications for the position for which you are applying. Only complete applications submitted before the closing date of this announcement will be reviewed. - Applicants must meet the minimum qualifications to continue in the selection process for this position. Do not use "see resume" or "see attached" statements on your application. - Cover letters and resumes will not be accepted in lieu of the official State of Colorado online application. Part-time work experience will be prorated. - List your employment history starting with the most recent job, including part-time, temporary, and volunteer jobs. If more than one job was held with a given organization, list each job held as a separate period of employment. - Information must be accurate, including dates of employment. If it is found that information provided is falsified, you will not be considered for a job with the State of Colorado and/or may be removed from a job after hire. - The eligible list established from this posting may be used to fill additional vacancies. Email Address: All correspondence regarding your status in the selection/examination process will be conducted via email. Please set up your e-mail to accept messages from "state.co.us" and "info@governmentjobs.com" addresses. It is your responsibility to ensure that your email will accept these notices and/or review your junk mail and spam filtered email. If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director. Appeal Rights: An applicant who has been removed from an employment list or removed from consideration during the selection process may request a review by the State Personnel Director. As an applicant directly affected by the results of the selection or comparative analysis process, you may file a written appeal with the State Personnel Director. Review of the completed, signed and submitted appeal will be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative. This form must be completed and delivered to the State Personnel Board by email at dpa_state.personnelboard@state.co.us within ten (10) calendar days from your receipt of notice or acknowledgement of the Department's action. For further information on the Board Rules, you can refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov/board-rules. Equity, Diversity, and Inclusion Compliance The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness. The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities. The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.
Compliance Auditor
State of ColoradoThe State of Colorado is located in the Rocky Mountain region of the western United States. It entered the 100-year-old Union in 1876, earning the nickname "Cen
Title: SNAP Compliance Auditor Location: Denver United States Salary $4,906.00 - $7,849.00 Monthly Location Denver Metro, CO Job Type Full Time Job Number IHA-02049 04.01.2026 Department Colorado Department of Human Services Division Admin Solutions FLSA Determined by Position Type of Announcement This position is open only to Colorado state residents. Primary Physical Work Address 3656 W Princeton Cir, Denver, CO 80236, USA FLSA Status Exempt; position is not eligible for overtime compensation. Salary Note Although the full salary range for this position is provided, appointments are typically made at or near the range minimum. How To Apply Please submit an online application for this position at https://www.governmentjobs.com/careers/colorado. Reach out to the Department Contact to apply using a paper application, including any supplemental questions. Failure to submit a complete and timely application may result in the rejection of your application. Applicants are responsible for ensuring that application materials are received by the appropriate Human Resources office before the closing date and time listed. Job Description: This position is open to current Colorado residents only Please note: This recruitment may be used to fill multiple vacancies. Work Unit: The Public Assistance Quality Assurance (PAQA) unit exists to: - Administer the federally mandated state "Quality Control System" that enhances payment accuracy and improves program administration including measuring program accuracy, assessment and resolution of potential liabilities, policy development, and formulating improvement plans; - Provide independent third-party review and quality improvement processes for the Supplemental Nutrition Assistance Program (SNAP) including case file audits, data collection, analysis and reporting on findings, providing technical and compliance training to county workers, assess and measure county adherence to state and federal regulations; and - Create strong partnerships with state and county staff to provide additional services such as non-quality assurance case reviews and consulting, risk analysis, and recommendations for reduction or elimination of timeliness, eligibility and payment errors. HYBRID POSITION 3 days remote, 2 days in office Please note: These working arragements are subject to change About This Position: The position exists to satisfy the requirements of the federally mandated management program by auditing a statistically valid, integrated sample of SNAP cases and to ensure that the state plan, policies and procedures comply with federal regulations and approved waivers. These reviews often include technical issues that require the resolution of compliance problems and reconciliation of divergent viewpoints. Provide continuous data to the federal, state and county agencies on frequency, magnitude and sources of non-compliance. Analyze both program performance and client services; directly advise state and/or county administrators of areas of risk and formulate improvement plans for eligibility and payment accuracy critically necessary to prevent errors and achieve program compliance. Provide technical and compliance training. Summary of Duties: Field Investigation: Independently audits agency actions and investigates selected households by interviewing recipients in their homes (including federally required travel to and from the recipient's home to complete a face-to-face interview), accessing databases and contacting a wide range of third-party sources to determine correctness of eligibility and/or payment. Audits/investigates until the incumbent determines sufficient data has been obtained. Advises clients of potential eligibility for other public assistance programs administered by the Colorado Department of Human Services. Case File Evaluation/Analysis and Reports: Evaluates validity of gathered data through a self-initiated determination; arrives at an accurate conclusion by researching federal and state regulations and federally mandated processes, and determines which federal, state or Quality Control (QC) regulations apply to each case. This task includes reviewing data located in a variety of computer systems and imaged documents with varying degrees of gray scale, color, or highlighted text. Completes secondary peer reviews to ensure accuracy prior to informing federal, state, and county agencies of the results of the audit. Apprises federal, state and county agencies of the results of investigation and analysis, by compiling and submitting comprehensive written reports within federally mandated processes and timeframes. Directs county agencies to terminate or modify benefits. Confers with program administrators to resolve differences between QC conclusions and federal/state policy, representing, justifying and negotiating QC findings in federal and state arbitration hearings. Correction Action Planning: Participates in corrective action planning as a result of audits of and rebuttals from counties and feedback from our federal partners. Identifies where and how the error occurred, provides technical assistance and advice regarding error reduction strategies, and participates in the development of processes to prevent similar errors in the future. Other Duties as Assigned This position may be called upon to provide coverage of duties for another staff person, requested to attend and participate in assorted conferences (i.e.; Colorado Welfare Fraud Council (CWFC) Conference, Social Services Technical and Business Staff (SSTABS) Conference), and requested to provide training to internal staff. Experience Only: Six (6) years of experience in Social Services, Human Services, SNAP, Medicaid, SSA, Rules and Regulations, Public Assistance, TANF, Adult Financial services or Cash Assistance with at least two (2) years of recent experience with determining SNAP initial and ongoing eligibility and payment including interviewing applicants to determine accurate household circumstances. - The SNAP experience must include a current working knowledge of SNAP program rules, policies, and processes as well as entering data into the Colorado Benefits Management System (CBMS). OR Education and Experience: A combination of related education and/or relevant experience in Social Services, Human Services, SNAP, Medicaid, SSA, Rules and Regulations, Public Assistance, TANF, Adult Financial services or Cash Assistance equal to six (6) years with at least two (2) years of recent experience with determining SNAP initial and ongoing eligibility and payment including interviewing applicants to determine accurate household circumstances. - The SNAP experience must include current working knowledge of SNAP program rules, policies, and processes as well as entering data in the Colorado Benefits Management System (CBMS). Preferred Qualifications - More than 3 years of experience with SNAP eligibility and payment determination, as well as trouble shooting CBMS data entry and system issues; and - Experience reviewing SNAP case files for eligibility and processing accuracy - Experience providing comprehensive findings and recommendations for process and eligibility improvement. - Spanish speaking preferred Conditions of Employment - Full background check and reference check required - This position requires State of Colorado residency at the time of application and residency within the state throughout the duration of employment in this position. - Motor Vehicle Check , if the employee will drive a state-owned vehicle, either in an on-going capacity while performing their normal day-to-day job duties OR on occasion for training/meetings/client visits/etc. - Must possess a valid, non-restricted Colorado Driver's License - Position requires State-wide travel to interview SNAP clients in their homes, which may include high risk areas and exposure to potentially dangerous situations. - Position requires training and process evaluation at local county offices of Human/Social Service; - Former State employees who were disciplinarily terminated or resigned in lieu of termination must: - Disclose that information on the application. - Explain why the prior termination or resignation should not disqualify you from the current position. - Provide your employee number from your prior State employment. Absent extraordinary circumstances, prior disciplinary termination or resignation in lieu of termination and failure to provide this information will disqualify the applicant from future State employment with CDHS. CDHS Selection Process Explanation Employment history is calculated on a full-time basis (40/hrs per week). Part-time employment is calculated on a prorated basis to determine qualifications. Be sure your application specifically addresses your qualifications, experience, work products, and accomplishments as they relate to the position and minimum requirements. - Preferred Qualifications & Competencies: - Relevant years of state service experience. Minimum Qualification Screening Process A Human Resources Analyst will review the work experience/job duties sections of the online job application to determine whether your experience meets the minimum qualifications for the position. You must complete the official State of Colorado online application. Cover letters and resumes WILL NOT be reviewed during the minimum qualifications screening process. You must specifically document your work experience and qualifications. Do not use "see resume" or "see attached." You must meet the minimum qualifications to continue in the selection process. Part-time work experience will be prorated. Comparative Analysis Process - Structured Application Review After minimum qualification screening, the comparative analysis process will involve a review and rating of all the information you submit. The comparative analysis step may also include your results from an eSkills Test. Your Work Experience/Job Duties Document your work experience/job duties to the extent to which you possess the skills, education, experience, minimum qualifications, and preferred qualifications. If listed, answer all supplemental questions as your answers to these questions will be evaluated during this phase. Provide at least 4-8 sentences for each supplemental question. Supplemental Questions Answer the supplemental questions completely and thoughtfully. We will rate your answers based on the content of your response and your writing skills (spelling, grammar, and clarity of your writing). Appeal Rights You may file an appeal with the State Personnel Board or request a review by the State Personnel Director if your application is eliminated. You will find the appeals process, the official appeal form, and how to deliver it on the State Personnel Board website. - You or your representative must sign and submit the official appeal form for review. - You can find the official appeal form here. - You must be deliver the official appeal form to the State Personnel Board: - By email (dpa_state.personnelboard@state.co.us), or - Postmarked in US Mail to(1525 Sherman Street, 4th Floor, Denver CO 80203, or - Hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or - Faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the department's action. Contact the State Personnel Board for assistance: - At (303) 866-3300, or - Refer to the Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, within the Rules webpage. How to Apply The Assessment Process About Us and Benefits: If your goal is to build a career that makes a difference, join the dedicated people of the Colorado Department of Human Services (CDHS). Our professionals strive to design and deliver high quality human and health services that improve the safety, independence, and well-being of the people of Colorado. Each of us is committed to contributing to a safe and accessible CDHS. In addition to a great location and rewarding and meaningful work, we offer: - Strong, secure, yet flexible retirement benefits including a PERA Defined Benefit Plan or PERA Defined Contribution Plan plus 401(k) and 457 plans - Medical and dental health plans - Employer supplemented Health Savings Account - Paid life insurance - Short- and long-term disability coverage - 11 paid holidays per year plus vacation and sick leave - State of Colorado Employee BenefitHub Resource Center - Employee Wellness program - Excellent work-life programs, such as flexible schedules, training and more - Remote work arrangements for eligible positions - *Some positions may qualify for the Public Service Loan Forgiveness Program. Our Values - We believe in a people-first approach: We prioritize the needs, well-being, and dignity of the individuals, families and communities we serve. We commit to respect, fairness and access in every decision, policy and interaction. We engage client voices and experiences in the development and implementation of the services we provide. - Balance creates quality of life: We want our team to be resilient through a supportive workplace that values flexibility, health and wellness, and employee engagement. - We hold ourselves accountable: We take responsibility through our actions, programs, and results for the state of health and human services in Colorado. - Transparency matters: We are open and honest with employees, our partners, the Coloradans we serve, and the public. - We are ethical: We abide by what is best for those we serve by doing what is right, not what is easy. - Collaboration helps us rise together: We work together with all partners, employees, and clients to achieve the best outcomes for Coloradans. ADA Accommodations CDHS is committed to a Colorado for ALL qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment. This includes completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or performing essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your. EEO Statement ~THE STATE OF COLORADO IS AN EQUAL OPPORTUNITY EMPLOYER~ We are committed to increasing a "Colorado for ALL" of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of all backgrounds and abilities. The State of Colorado believes that a "Colorado for ALL" drives our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law. Additional Support For Your Application Toll Free Applicant Technical Support If you experience technical difficulty with the NEOGOV system (e.g. uploading or attaching documents to your online application) call NEOGOV technical support at 855-524-5627 Mon-Fri between 6 am and 6 pm (Pacific Time). Helpful hints: if you are having difficulty uploading or attaching documents to your application 1) ensure your documents are PDF or Microsoft Word files and 2) close the document before you attempt to upload (attach) it.

