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 1-2 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.

• Perform daily QA to ensure accuracy of completed coding and provide targeted coding education and feedback • Validate ICD‑10‑CM, CPT®, HCPCS, and modifier assignment against clinical documentation to ensure accuracy and compliance with AMA CPT, ICD-10, CMS, NCCI, and payer-specific guidelines • Conduct medical chart audits of professional services across multiple specialties • Identify coding discrepancies, compliance risks, trends, root causes, and documentation gaps • Support coding education through feedback, targeted training, and reference materials • Prepare clear, defensible audit documentation including rationale and references • Provide actionable recommendations to address audit findings and reduce future risk • Track audit outcomes and trends to support leadership reporting and risk mitigation strategies • Support denial prevention, resolution and appeal strategies • Collaborate across teams to assist with coding support • Maintain confidentiality and comply with HIPAA and organizational policies

• Responsible for the auditing of inpatient coders and/or inpatient “audit the auditors” to ensure coding accuracy and DRG accuracy of a minimum of 95% is met. • Perform quality checks/audits on visits coded as per client SOPs. • Perform calibration audits. • Suggest improvements and schedule calibration sessions with offshore team counterparts and leaders. • May assist in preparing audit reports, share direct feedback to coders and auditors on areas of opportunity, participate in client interactions and internal stakeholder meetings. • Firm understanding of the clinical documentation guidelines. • Monitor compliance of coding guidelines and ensure errors are identified during audits are corrected as appropriate, and corrective action is initiated before the claim is rebilled to the insurance. • Conduct analysis and present summary of findings to leadership in a clear, concise, convincing, and actionable format. • Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes (ICD-PCS), MS-DRG, APR DRG, POA, SOI & ROM assignments. • Ensures capture/reporting of appropriate code(s) by utilizing coding guidelines established by: The Centers for Disease Control (CDC), ICD-CM Official Coding Guidelines for Coding and Reporting, Centers for Medicare/Medicaid Services (CMS) ICD-PCS Official Guidelines for Coding and Reporting American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification American Health Information Management Association (AHIMA) Standards of Ethical Coding Client coding procedures and guidelines. • Navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs, APR DRGs, and identify HACs and PSIs or other indicators that could impact quality data and hospital reimbursement. • Reviews inpatient health record documentation to assess the presence of clinical evidence/indicators to support diagnosis codes and MS-DRG, APR DRG assignments to potentially decrease denials. • Maintains a high degree of professional and ethical standards. • Focuses on updating coding skills, knowledge, and accuracy by participating in coding team meetings and educational conferences. • Maintains CEUs as appropriate for coding credentials as required by credentialing associations. • Maintains current knowledge of changes in inpatient reimbursement guidelines and regulations as well as new applications or settings for inpatient coding e.g., Hospital at Home. • Ensure patient information is correct and appropriate signatures are on all medical records. • Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation. • Maintains a working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, Code of Ethics, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior. • Perform other duties as assigned.

Location: Avera McKennan Hospital Worker Type: Regular Work Shift: Day Shift (United States of America) Pay Range: The pay range for this position is listed below. Actual pay rate dependent upon experience. $22.75 - $32.75 Position Highlights You Belong at Avera Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter. A Brief Overview Responsible for reviewing retail prescriptions that qualified for the hospital's 340B Drug Pricing Contract Pharmacy Program. This role is required to review all eligible prescriptions and check eligibility against the hospital's electronic medical record for appropriate matching documentation and make corrections within the pharmacy's reprocessing window and provide regular feedback to the leadership of Pharmacy Business & Analytics on auditing trends. What you will do - Review, analyze and determine eligibility of contract pharmacy claims by investigating patient records in hospital EMR to ensure each prescription meets the 340B patient definition. - Reverse ineligible claims within pharmacy reprocessing window. - Communicate audit results with the Pharmacy Business & Analytics Team, External 340B Software Vendor, Contract Pharmacies, Avera 340B Steering Committee and Avera Corporate Compliance Committee. - Document all requested reversals and ensure reversals occur Maintain accurate provider file for hospital's assigned to. - Remain current with 340B patient definition and current federal auditing guidelines and best practices. - Monitor and report trending of third party contract pharmacy audits to Director of Pharmacy Business & Analytics, Avera 340B Steering Committee and Avera Corporate Compliance Committee. Essential Qualifications The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer. Required Education, License/Certification, or Work Experience: - Associate's or certified pharmacy technician. or - Certified Pharmacy Technician (CPhT) - Pharmacy Technician Certification Board (PTCB) Certified as a pharmacy technician by the Pharmacy Technician Certification Board (PTCB) Upon Hire - 1-3 years experience within a hospital business office, medical related field, health plan, third party administrator, or managed care industry Expectations and Standards - Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community. - Promote Avera’s values of compassion, hospitality, and stewardship. - Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity. - Maintain confidentiality. - Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment. - Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable. Benefits You Need & Then Some Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future. - PTO available day 1 for eligible hires. - Up to 5% employer matching contribution for retirement - Career development guided by hands-on training and mentorship Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to talent@avera.org.