Manager, Coding Quality and Compliance Auditing

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.

Oak Street Health®, a part of CVS Health, helps older adults stay healthier and live fuller lives through our 230 centers across 27 states. Our value-based care model helps us consistently deliver better patient experiences and outcomes.

Oak Street Health seeks an experienced Manager of Coding Quality and Compliance. This role requires deep medical coding expertise, experience contributing to Epic workflow design, and confidence working across teams (Rev Cycle, Coding, Clinical Documentation, executive leadership). You are a people manager, subject matter expert, problem solver, and relationship builder with a talent for creative problem solving & execution. An early adapter of Artificial Intelligence in coding who can design AI-enabled workflows.

Excellent at communicating audit & compliance concepts to colleagues in other functions.

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.

• Internal Auditing Controls:
  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).
• VBC & RADV Audit Operations:
  Manages external audit execution and internal CMS Risk Adjustment Data Validation (RADV) readiness, conducting routine mock RADV audits to validate HCC chronic condition support.
• Query Compliance Oversight:
  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.
• Epic Rule Engine Optimization:
  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.
• Deletion Log Maintenance & Overpayment Tracking:
  Mandates and tracks the technical Deletion & Reconciliation workflow, enforcing strict adherence to the 60-day federal over payment refund standard.
• Payer Data Ingestion Auditing:
  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.

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…