Certified Medical Coding Analyst — Audit & Compliance

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

Job summary

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews ensuring CPT/HCPCS/ICD-10 compliance and accurate documentation. The role requires auditing records, applying CMS and internal guidelines, and collaborating with Medical Directors to validate decisions.

The analyst will identify billing anomalies, support provider education, and maintain thorough records while contributing to process improvements. This is a full-time position with a comprehensive benefits package.

Qualifications

• 2+ years of experience in medical coding, claims review, auditing.
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements
• Maintains up-to-date coding knowledge incl. new changes to coding compliance and reimbursement.
• Experience with researching coding and policies.
• Experience with Microsoft products; Excel and Word

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS/modifiers billed align with documentation.
• Research and apply state, CMS and organizational guidelines related to the audit.
• Review and discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Prepare clear, concise summaries of findings and present outcomes to internal partners.
• Track and trend recurring coding and billing issues to inform process improvements.

Skills

Medical coding

Claims review

Auditing

CPT/HCPCS/ICD-10

CMS 1500 / UB04

MS Excel

Word

Encoder Pro

Education

AAPC CPC Certification

High School diploma or GED

Tools

Encoder Pro

MS Word

Job description

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews ensuring CPT/HCPCS/ICD-10 compliance and accurate documentation. The role requires auditing records, applying CMS and internal guidelines, and collaborating with Medical Directors to validate decisions.

The analyst will identify billing anomalies, support provider education, and maintain thorough records while contributing to process improvements. This is a full-time position with a comprehensive benefits package.