Certified Coding Auditor & Claims Quality Analyst

CVS Health Corporation; Hartford (CT); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus program eligibility

Professional development opportunities

Job summary

CVS Health Corporation seeks a Certified Coding Analyst to perform medical claim reviews, ensure correct coding, and verify documentation. You will apply CPT/HCPCS rules, CMS guidelines, and organizational policies while communicating findings to internal partners.

The role requires CPC certification, 2+ years in coding/auditing, and strong attention to detail. Join a team focused on accurate coding, compliance, and quality in health care.

Qualifications

• AAPC CPC certification required.
• 2+ years of medical coding, claims review, auditing experience.
• Proficiency with CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements knowledge.
• Maintains up-to-date coding knowledge including policy changes.
• Experience researching coding and policies.
• Proficient with Microsoft Excel and Word.
• Strong written and verbal communication skills.

Responsibilities

• Audit medical records to ensure CPT/HCPCS or modifiers billed match documentation.
• Research and apply state, CMS and organizational guidelines related to audits.
• Review and discuss cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Prepare clear, concise summaries of findings.
• Present case outcomes and rationale to internal partners clearly.
• Track recurring coding and billing issues to inform improvements.
• Maintain appropriate records and meet production metrics.

Skills

CPC certification

Medical coding

Auditing

Attention to detail

Written and verbal communication

Excel

Word

Education

AAPC CPC Certification

High School diploma or GED

Tools

Encoder Pro

Excel

Word

Job description

CVS Health Corporation seeks a Certified Coding Analyst to perform medical claim reviews, ensure correct coding, and verify documentation. You will apply CPT/HCPCS rules, CMS guidelines, and organizational policies while communicating findings to internal partners.

The role requires CPC certification, 2+ years in coding/auditing, and strong attention to detail. Join a team focused on accurate coding, compliance, and quality in health care.