Certified Medical Coding Auditor

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

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst in Raleigh, NC to perform medical claim reviews for waste and error and ensure coding accuracy in line with CPT, ICD-10, HCPCS, and modifiers.

You will audit medical records, apply CMS/state guidelines, discuss cases with Medical Directors, and prepare concise findings for internal partners while maintaining records and meeting production metrics.

Qualifications

• AAPC CPC certification
• 2+ years of medical coding and claims review experience
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers
• CMS 1500 and UB04 data elements
• Maintains up-to-date coding knowledge and policy changes
• Experience researching coding and policies
• Proficient with Microsoft Excel and Word
• Strong attention to detail and data interpretation
• Strong written and verbal communication

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS or modifiers match documentation.
• Research and apply state, CMS and organizational guidelines related to the audit.
• Review and discuss cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions, policies.
• Identify potential billing errors, abuse, and fraud.
• Prepare clear summaries of findings.
• Present outcomes and rationale to internal partners.
• Track recurring coding/billing issues to inform improvements.
• Maintain records and follow workflows to meet production metrics.

Skills

CPC certification

Medical coding

Claims review

Auditing

Excel

Attention to detail

Communication

Education

High School diploma or GED

Tools

Excel

Word

Job description

CVS Health Corporation is seeking a Certified Coding Analyst in Raleigh, NC to perform medical claim reviews for waste and error and ensure coding accuracy in line with CPT, ICD-10, HCPCS, and modifiers.

You will audit medical records, apply CMS/state guidelines, discuss cases with Medical Directors, and prepare concise findings for internal partners while maintaining records and meeting production metrics.