Certified Medical Coding Audit Specialist

CVS Health Corporation; Dover (DE); 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 compliant documentation across medical and institutional providers. You will audit records and discuss findings with Medical Directors as needed.

The role requires CPC certification, 2+ years in coding and auditing, and proficiency with CPT/HCPCS/ICD-10 guidelines, with attention to detail and strong communication skills. Full-time, on-site in a healthcare setting.

Qualifications

• AAPC CPC certification required.
• 2+ years in medical coding, claims review, auditing.
• Knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements knowledge.
• Proficient with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS or modifiers billed align with documentation.
• Research state and CMS guidelines for audits with minimal support.
• Review cases with Medical Directors to validate decisions as needed.
• Identify potential billing errors, abuse and fraud.
• Prepare concise findings summaries and present outcomes to internal partners.
• Track recurring coding issues to inform process improvements.

Skills

Attention to detail

Communication skills

Data interpretation

Microsoft Excel

Microsoft Word

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 compliant documentation across medical and institutional providers. You will audit records and discuss findings with Medical Directors as needed.

The role requires CPC certification, 2+ years in coding and auditing, and proficiency with CPT/HCPCS/ICD-10 guidelines, with attention to detail and strong communication skills. Full-time, on-site in a healthcare setting.