Manager, Coding Quality and Compliance Auditing
Role Description:
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.
Job Overview:
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 subject matter expert, problem solver, and relationship builder with a talent for creative problem solving & execution. You are excellent at communicating audit & compliance concepts to colleagues in other functions.
You will focus on: Technical chart auditing, Epic work queue rules maintenance, deletion log tracking, external CMS RADV/OIG audit operational preparation, and AHIMA query governance.
Specific examples of workstreams include:
- 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 overpayment 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.
Required Qualifications:
- 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
Preferred Qualifications: • CRC • RHIT or RHIA Oak Street Health is on a mission to “Rebuild healthcare as it should be'', providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patient’s communities, and focused on the quality of care over volume of services. We’re an organization on the move! With over 150 locations and an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody “Oaky” values and passion for our mission.
Oak Street Health 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
Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply.
