Certified Medical Coding Auditor

Internationalinsuranceprofessionals; Boston, Northern (MA, KY); Hybrid; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Boston, MA is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and documentation compliance across CPT/HCPCS, ICD-10 and modifiers.

You will audit medical records, apply CMS and state guidelines, discuss cases with Medical Directors, identify billing anomalies, and prepare clear findings while maintaining records and production metrics.

Qualifications

• AAPC CPC certification
• 2+ years of medical coding, claims review, auditing experience
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers
• CMS 1500 and UB04 data elements
• Maintains up-to-date coding knowledge, including changes to coding compliance and reimbursement
• Experience researching coding and policies
• Proficiency with Excel and Word
• Strong written and verbal communication skills

Responsibilities

• Audit medical records to ensure CPT/HCPCS/modifier accuracy with documentation
• Apply CMS/state guidelines related to audits
• Discuss cases with Medical Directors to validate decisions
• Assist with investigation of coding questions and policies
• Identify billing errors, waste, and fraud
• Prepare clear, concise findings summaries
• Present outcomes and rationale to internal partners
• Maintain records and meet production metrics
• Follow workflows with minimal supervision

Skills

Medical coding experience

Claims review

Auditing

CPT/HCPCS/ICD-10 knowledge

CMS 1500/UB04 knowledge

Documentation review

Excel/Word

Education

AAPC CPC Certification

High School diploma or GED

Tools

Encoder Pro

Microsoft Excel

Microsoft Word

Job description

CVS Health in Boston, MA is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and documentation compliance across CPT/HCPCS, ICD-10 and modifiers.

You will audit medical records, apply CMS and state guidelines, discuss cases with Medical Directors, identify billing anomalies, and prepare clear findings while maintaining records and production metrics.