Certified Medical Coding Auditor - Claims & Compliance

CVS Health Corporation; Jefferson City (MO); 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 is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding practices align with documentation and state/federal/company requirements. The analyst will determine correct coding and review medical records accordingly.

Responsibilities include audits, applying guidelines, discussing cases with Medical Directors, identifying billing anomalies, and preparing concise findings. A CPC certification and 2+ years of coding experience are required.

Qualifications

• AAPC CPC certification and knowledge of CPT/HCPCS/ICD-10
• 2+ years of medical coding, claims review, and auditing experience
• Knowledge of CMS 1500 and UB04 data elements
• Proficiency with Microsoft Excel and Word
• Strong attention to detail and data interpretation
• Excellent written and verbal communication skills

Responsibilities

• Conduct comprehensive medical record audits for CPT/HCPCS consistency with documentation
• Research and apply CMS and organizational guidelines related to audits
• Review cases with Medical Directors to validate decisions
• Identify potential billing errors, abuse, and fraud
• Prepare clear summaries of findings and present outcomes to internal partners
• Track recurring coding issues to inform process improvements
• Maintain proper records and documentation
• Follow workflows to meet production metrics

Skills

Medical coding

Claims review

Auditing

Microsoft Excel

Microsoft Word

Attention to detail

Written communication

Verbal communication

Education

AAPC CPC certification

High School diploma or GED

Tools

Encoder pro

Excel

Word

Job description

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding practices align with documentation and state/federal/company requirements. The analyst will determine correct coding and review medical records accordingly.

Responsibilities include audits, applying guidelines, discussing cases with Medical Directors, identifying billing anomalies, and preparing concise findings. A CPC certification and 2+ years of coding experience are required.