Associate Manager, Audit Group Leader

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

Job Description Summary

This position oversees the daily operations to ensure accurate and complete auditing of member evaluations. Included in this role is implementing process improvements, mentorship of new direct reports, oversight of time and attendance of direct reports, and monitoring performance metrics.

 

 

Primary Job Duties & Responsibilities

 -Oversees Coding Audit- day to day process and holds the team accountable.
 -Mentors new Auditors and coaches established Auditors when needs are identified.
- Monitors and manages key performance indicators for the Audit team, and aids in creating action plans for improvement.
- Manages day to day processes.
 -Completes timecards and monitors attendance.
 -Completes quarterly and annual performance reviews for direct reports.
- Participates in the process of hiring members of the Audit team.
 -Collaborates to ensure seamless coding and auditing processes
 -Interfaces with management to maintain the operations of the auditing system and record integrity.
 -Makes recommendations for auditing policy/changes.
 -Maintains coding certification
 -Follows all legal and policy requirements for HIPAA protected data
 -Communicates in a timely manner and effectively with leadership regarding issues with the health risk assessments/evaluations and/or corrections required to the health risk assessments/evaluations.
- Codes and audits charts as needed

Experience

• 5 to 7 years of prior relevant experience
•  ICD-10 coding experience with 4 or more years of auditing experience
• Prior experience managing/supervising coding teams required.
•  Experience and knowledge of Medicare, ACA Exchange and Medicaid HCC coding.
• Experience with medical record documentation.

 

Essential Qualifications

• Certified Coding Specialist (CCS), Certified Coding Specialist for Providers (CCS-P) or Certified Professional Coder (CPC) required
• CRC credential is required
• Knowledge of coding, compliance and reimbursement procedures related to Medicare, Medicaid, and Commercial risk adjustment.
• Strong leadership skills
• Fluently speak, read, and write English
• Good verbal and written communication skills
• Proven ability to prioritize and multitask
•  Basic skills in MS Office and Google Suite
• Basic analytical skills
•  Extensive knowledge of CMS medical record and ICD-10 coding guidelines

Preferred Qualifications

• CPMA
• Experience in Risk Adjustment Data Validation (RADV) or similar government audit experience

 

Education

• Post secondary /high school education or specialized training, i.e., technical/vocational programs
  
  

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $102,000.00

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: 01/31/2027

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.