Certified Medical Coding Auditor – Accuracy & Compliance

CVS Health Corporation; Denver (CO); 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

Wellness programs

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error and ensure compliance with coding practices through thorough record reviews of medical and institutional providers. The analyst will determine correct coding and documentation during review, ensuring state, federal and company requirements are met.

The role includes auditing medical records for CPT/HCPCS compliance, applying CMS guidelines, coordinating with Medical Directors,

Qualifications

• AAPC CPC certification and active coding credential.
• 2+ years of experience in medical coding, claims review, auditing.
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements familiarity.
• Keeps coding knowledge up to date with changes to compliance and reimbursement.
• Experience researching coding and policies.
• Proficient with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS accuracy against documentation.
• Apply state, CMS and organizational guidelines to audits with minimal support.
• Review cases with Medical Directors to validate decisions as needed.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse and fraud and document findings clearly.
• Prepare concise summaries of findings and rationale for internal partners.
• Track recurring coding and billing issues to inform process improvements.
• Maintain records and documentation for audits and reviews.
• Follow department workflows to meet production metrics.

Skills

CPC Certification

Medical coding experience

Claims review

Auditing

Microsoft Excel

Attention to detail

Communication skills

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Job description

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error and ensure compliance with coding practices through thorough record reviews of medical and institutional providers. The analyst will determine correct coding and documentation during review, ensuring state, federal and company requirements are met.

The role includes auditing medical records for CPT/HCPCS compliance, applying CMS guidelines, coordinating with Medical Directors,