Certified Coding Auditor - Accuracy & Compliance Expert

CVS Health Corporation; Harrisburg (Dauphin County); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Coding Analyst to review medical records, apply coding guidelines, and ensure compliant CPT/HCPCS/ICD-10 coding. The role emphasizes accuracy, data interpretation, and collaboration with Medical Directors to validate decisions.

Qualified candidates bring CPC certification, 2+ years of coding/auditing experience, and proficiency with Excel and Word. This full-time position offers a comprehensive benefits package and competitive pay.

Qualifications

• AAPC CPC certification required.
• 2+ years of medical coding, claims review or auditing experience.
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers.
• Experience with CMS 1500 and UB04 data elements.
• Keeps coding knowledge up to date with changes.
• Experience researching coding policies and guidelines.
• Proficiency with Microsoft Excel and Word.

Responsibilities

• Perform medical record audits to verify CPT/HCPCS or modifiers align with documentation.
• Apply state, CMS and organizational guidelines during audits with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with coding-related investigative research on policies.
• Identify potential billing errors, abuse and fraud.
• Prepare concise findings summaries.
• Present outcomes and rationale to internal partners clearly.
• Track recurring coding issues to inform process improvements and training.
• Maintain thorough records and documentation.
• Follow workflows to meet daily production metrics.

Skills

Attention to detail

Written communication

Verbal communication

Research skills

Coding standards knowledge

Education

AAPC CPC Certification

High School diploma or GED

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Coding Analyst to review medical records, apply coding guidelines, and ensure compliant CPT/HCPCS/ICD-10 coding. The role emphasizes accuracy, data interpretation, and collaboration with Medical Directors to validate decisions.

Qualified candidates bring CPC certification, 2+ years of coding/auditing experience, and proficiency with Excel and Word. This full-time position offers a comprehensive benefits package and competitive pay.