Certified Medical Coding Audit Specialist

Internationalinsuranceprofessionals; Lincoln (NE); 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 compliance across medical and institutional providers. You will verify CPT/HCPCS, ICD-10, and modifiers, and ensure CMS 1500/UB04 data elements are correct.

Collaboration with Medical Directors will support decisions and process improvements. Ideal candidates hold AAPC CPC certification with 2+ years of coding experience, strong Excel/Word skills, and a detail-oriented,

Qualifications

• Requires AAPC CPC certification and 2+ years of medical coding, claims review or auditing experience.
• Knowledge of CPT, HCPCS, ICD-10 and modifiers; CMS 1500/UB04 data elements.
• Proficient with Excel and Word; up-to-date coding knowledge and policy research abilities.

Responsibilities

• Perform comprehensive medical record audits to verify CPT/HCPCS/modifier accuracy against documentation.
• Research state, CMS, and organizational guidelines to support audit findings.
• Discuss cases with Medical Directors to validate decisions as needed.
• Identify billing errors, abuse and fraud; prepare concise findings summaries.
• Maintain records and produce outputs to meet production metrics.

Skills

CPC Certification

Medical coding

Auditing

CPT/HCPCS

ICD-10

CMS 1500/UB04

Excel

Word

Attention to detail

Communication

Education

CPC Certification

High School diploma

Job description

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding compliance across medical and institutional providers. You will verify CPT/HCPCS, ICD-10, and modifiers, and ensure CMS 1500/UB04 data elements are correct.

Collaboration with Medical Directors will support decisions and process improvements. Ideal candidates hold AAPC CPC certification with 2+ years of coding experience, strong Excel/Word skills, and a detail-oriented,