Certified Coding Analyst - Medical Claims Audit

CVS Health Corporation; Saint Paul (MN); On-site; USD 44,000 - 102,000; Full time

Job summary

CVS Health Corporation in the United States is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance with CPT/HCPCS/ICD-10 guidelines across medical and institutional providers. The role requires AAPC CPC certification, 2+ years of coding/auditing experience, strong data interpretation skills, and proficiency with Excel and Word.

You will collaborate with Medical Directors and internal partners to improve coding accuracy

Qualifications

• AAPC CPC certification required.
• 2+ years of medical coding, claims review, auditing.
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements.
• Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement.
• Experience with researching coding and policies.
• Experience with Microsoft products; Excel and Word.
• Strong attention to detail and ability to review and interpret data.
• Demonstrates strong written and verbal communication skills.

Responsibilities

• Conduct a comprehensive medical record audit to ensure CPT/HCPCS or modifiers billed are consistent with medical record documentation.
• Research and accurately apply state, CMS and organizational guidelines related to the audit with minimal support.
• Review and discuss cases with Medical Directors to validate decisions as needed.
• Assist with investigative research related to coding questions, state and federal policies.
• Identify potential billing errors, abuse, and fraud.
• Prepare clear, concise summary of findings
• Ability to present case outcomes and decision rationale in a clear, concise manner to internal partners.
• Track and trend recurring coding and billing issues to inform process improvements and provider education.
• Maintain appropriate records, files, documentation, etc.
• Uses department resources regularly
• Follows workflows with minimal assistance to perform daily work to meet production metrics

Skills

Medical coding

Auditing

Attention to detail

Communication skills

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Encoder Pro

Job description

CVS Health Corporation in the United States is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance with CPT/HCPCS/ICD-10 guidelines across medical and institutional providers. The role requires AAPC CPC certification, 2+ years of coding/auditing experience, strong data interpretation skills, and proficiency with Excel and Word.

You will collaborate with Medical Directors and internal partners to improve coding accuracy