Certified Medical Coding Auditor

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst to conduct comprehensive medical record audits, ensure CPT/HCPCS consistency, and apply CMS and company guidelines. The role requires CPC certification and 2+ years of coding, claims review, or auditing experience.

The Analyst will review cases with Medical Directors, research coding policies, and identify billing errors or fraud while maintaining thorough documentation and clear communication with internal partners.

Qualifications

• AAPC CPC certification is required.
• 2+ years of experience in medical coding, claims review, auditing.
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers.
• Familiar with CMS 1500 and UB04 data elements.
• Proficient with researching coding and policies.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS/modifier consistency.
• Apply state, CMS and organizational guidelines related to audits.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Prepare clear summaries of findings and present outcomes to stakeholders.
• Track recurring coding and billing issues for process improvements.
• Maintain appropriate records and documentation.

Skills

CPC Certification

Attention to detail

Communication skills

MS Excel

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Job description

CVS Health Corporation is seeking a Certified Coding Analyst to conduct comprehensive medical record audits, ensure CPT/HCPCS consistency, and apply CMS and company guidelines. The role requires CPC certification and 2+ years of coding, claims review, or auditing experience.

The Analyst will review cases with Medical Directors, research coding policies, and identify billing errors or fraud while maintaining thorough documentation and clear communication with internal partners.