Manager, Coding Quality and Compliance Auditing
About The Position
Oak Street Health, a part of CVS Health, helps older adults stay healthier and live fuller lives through its value-based care model. This role is for an experienced Manager of Coding Quality and Compliance who will focus on team management, technical chart auditing, building and scaling coding processes post Epic implementation, Epic workqueue rules maintenance, deletion log tracking, external CMS RADV/OIG audit operational preparation, and AHIMA query governance. The ideal candidate will have deep medical coding expertise, experience contributing to Epic workflow design, and confidence working across teams. They should be a people manager, subject matter expert, problem solver, and relationship builder with a talent for creative problem solving & execution, and an early adopter of Artificial Intelligence in coding who can design AI-enabled workflows. Excellent communication skills for explaining audit & compliance concepts to colleagues in other functions are essential.
Requirements
- Post secondary /high school education or specialized training, i.e., technical/vocational programs
- 5 to 7 years relevant experience
- 2 to 4 years of risk adjusted coding experience
- Certified Coding Specialist (CCS), Certified Coding Associate (CCA) or Certified Professional Coder (CPC)
- Credential of at least 3 years by AHIMA or AAPC required. Dual AAPC certification a plus. Credential must be current, in good standing, and maintained during employment.
- ICD-10 Coding certification
- ICD-9-CM coding experience
- ICD-10-CM coding experience
- Proven coding competency
- Prior medical chart auditing/quality experience
- Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes and pharmacology
- Experience working with and designing AI coding workflows
- Coding team management experience
Nice To Haves
- CRC
- RHIT or RHIA
Responsibilities
- Conducts daily quality checks and secondary reviews among coding audit staff to verify standard industry coding guide compliance (ICD-10-CM, CPT, HCPCS), E/M code selection accuracy, and compliant Modifier usage (e.g., Modifier 25).
- Manages external audit execution and internal CMS Risk Adjustment Data Validation (RADV) readiness, conducting routine mock RADV audits to validate HCC chronic condition support.
- Audits and enforces compliant Provider Query practices across coding and CDA staff, ensuring adherence to AHIMA/ACDIS standards to eliminate leading queries and maintain non-biased documentation integrity.
- Partners directly with IT analysts to translate high-risk OIG selection parameters (e.g., active stroke without hospital stay, or vascular codes without anticoagulants) and other Compliance priorities into native Epic tools.
- Mandates and tracks the technical Deletion & Reconciliation workflow, enforcing strict adherence to the 60-day federal overpayment refund standard.
- Audits incoming payer supplemental data files, gap-closure feeds, and automated clinical inference outputs to verify that suggested chronic conditions meet CMS coding standards before inclusion in risk-score submissions.
Benefits
- Mission-focused career impacting change and measurably improving health outcomes for medicare patients
- Paid vacation, sick time, and investment/retirement 401K match options
- Health insurance, vision, and dental benefits
- Opportunities for leadership development and continuing education stipends
- New centers and flexible work environments
- Opportunities for high levels of responsibility and rapid advancement
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
High school or GED
