Certified Coding Auditor (CPC), Analyst

Internationalinsuranceprofessionals; Raleigh (NC); On-site; USD 44,000 - 102,000; Full time

Job summary

CVS Health 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, modifiers and CMS guidelines across medical and institutional providers.

You will audit records, discuss cases with Medical Directors, identify billing issues, and prepare concise findings while maintaining documentation and contributing to process improvements.

Qualifications

• AAPC CPC certification required.
• 2+ years of medical coding, claims review or auditing experience.
• Knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements knowledge.
• Proficiency with Excel and Word.
• Strong attention to detail and data interpretation.
• Excellent written and verbal communication skills.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS modifiers align with documentation.
• Research and apply state, CMS and organizational guidelines with minimal support.
• Discuss cases with Medical Directors to validate decisions as needed.
• Assist with coding-related investigative research.
• 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 issues to inform improvements and training.
• Maintain thorough records and documentation.
• Follow workflows to meet production metrics.

Skills

Attention to detail

Strong communication

Policy research

Data interpretation

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Encoder Pro

Job description

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.

The Certified Coding Analyst will perform medical claim reviews for waste and error to ensure compliance with coding practices through a comprehensive record review for medical and institutional providers. The Analyst must have the ability to determine correct coding and appropriate documentation during the review of medical records. The Analyst must also ensure state; federal and company requirements are met.

• Conduct a comprehensive medical record audit to ensure the 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

Required Qualifications

• AAPC Certified professional Coder (CPC) certification
• 2+ years of experience in medical coding, claims review, auditing
• Strong knowledge of standard industry coding guides and guidelines including 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

Preferred Qualifications

• 1+ years of experience in appeal/recon medical coding, claims reviews, auditing
• Medicaid auditing experience
• Prior auditing experience in fraud, waste, abuse and error, or payment integrity
• Excellent communication skills
• Strong analytical and problem-solving skills
• Encoder pro experience

Education

• AAPC Certified Professional Coder Certification (CPC)
• High School diploma or GED

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $102,081.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/17/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.