Certified Coding Auditor - Healthcare Claims & Compliance

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst to perform comprehensive medical record audits and ensure compliant coding practices. The role requires CPC certification and 2+ years in medical coding, claims review, or auditing, with strong CPT/HCPCS/ICD-10 knowledge and CMS 1500/UB04 experience.

The analyst will review records, apply guidelines, discuss findings with Medical Directors, and identify billing errors or fraud.

Qualifications

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

Responsibilities

• Audit medical records to ensure CPT/HCPCS and modifiers align with documentation.
• Apply state, CMS and organizational guidelines to coding reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions as needed.
• Identify potential billing errors, fraud, or waste and prepare concise findings.
• Present outcomes and rationale clearly to internal partners and stakeholders.
• Track recurring coding issues to inform process improvements and provider education.

Skills

Attention to detail

Written & verbal communication

Coding guidelines

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Job description

CVS Health Corporation is seeking a Certified Coding Analyst to perform comprehensive medical record audits and ensure compliant coding practices. The role requires CPC certification and 2+ years in medical coding, claims review, or auditing, with strong CPT/HCPCS/ICD-10 knowledge and CMS 1500/UB04 experience.

The analyst will review records, apply guidelines, discuss findings with Medical Directors, and identify billing errors or fraud.