Certified Medical Coder & Audit Specialist

Hispanic Alliance for Career Enhancement; Massachusetts; Hybrid; USD 43,888 - 93,574; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. You will audit medical records for CPT/HCPCS alignment, prepare detailed findings, and communicate results to investigators and regulators.

The role requires 3+ years of coding or auditing experience and proficiency with CPT, ICD-10, CMS 1500, and UB04 guidelines. Ideal candidates will have CPC certification, strong analytical skills, and experience with Excel and

Qualifications

• CPC certification (AAPC) is required.
• 3+ years of medical coding or documentation auditing experience.
• Knowledge of CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements.
• Experience researching coding and policies.
• MS Excel and Word proficiency.

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS or modifiers match documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, Medicaid leadership, law enforcement, and regulators.
• Research and apply state or CMS guidelines related to audits.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Identify savings opportunities warranting prepayment review.
• Maintain records and documentation; follow workflows to meet metrics.
• Maintain up-to-date coding knowledge and respond to changes in compliance and reimbursement.

Skills

CPC Certification

Medical coding

Auditing

Excel

Word

Education

GED

AAPC CPC Certification

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. You will audit medical records for CPT/HCPCS alignment, prepare detailed findings, and communicate results to investigators and regulators.

The role requires 3+ years of coding or auditing experience and proficiency with CPT, ICD-10, CMS 1500, and UB04 guidelines. Ideal candidates will have CPC certification, strong analytical skills, and experience with Excel and