Certified Medical Coding Audit Analyst

CVS Health Corporation; City of Albany (NY); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

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, and state and federal requirements.

You will audit medical records, apply CMS guidelines, discuss cases with Medical Directors, identify billing issues, and prepare concise findings for internal partners. This is a full-time, on-site role with a 40-hour week.

Qualifications

• AAPC CPC certification and up-to-date coding knowledge required.
• 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.
• Proficiency with Microsoft Excel and Word.
• Attention to detail and ability to interpret data.
• Strong written and verbal communication skills.

Responsibilities

• Perform comprehensive medical record audits to verify CPT/HCPCS/modifier accuracy.
• Research CMS/state guidelines related to coding and audits with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, misuse and fraud through documentation reviews.
• Prepare clear summaries of findings and communicate outcomes to internal partners.
• Track recurring coding issues to inform process improvements and provider education.

Skills

Medical coding

Auditing

Attention to detail

Written communication

Verbal communication

Policy research

Education

AAPC CPC certification

High School diploma or GED

Tools

Excel

Word

Job description

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, and state and federal requirements.

You will audit medical records, apply CMS guidelines, discuss cases with Medical Directors, identify billing issues, and prepare concise findings for internal partners. This is a full-time, on-site role with a 40-hour week.