Certified Medical Coding Auditor & Claims Quality Analyst

Internationalinsuranceprofessionals; New Hampshire; Hybrid; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Job summary

CVS Health is seeking a Certified Coding Analyst to perform comprehensive medical claim reviews for waste and error, ensuring coding accuracy and proper documentation in accordance with state, CMS and company guidelines.

The role requires 2+ years in medical coding/auditing, CPC certification, and proficiency with CPT/HCPCS/ICD-10; neat attention to detail and strong communication are essential. Full-time position with a broad benefits package and a structured work environment.

Qualifications

• AAPC CPC certification required.
• 2+ years of medical coding, claims review, auditing experience.
• Knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements.
• Proficient with Microsoft Office (Excel and Word).

Responsibilities

• Audit medical records to verify CPT/HCPCS or modifiers align with documentation.
• Apply state, CMS and internal guidelines to audits with minimal supervision.
• Discuss cases with Medical Directors as needed.
• Investigate coding questions and relevant policies.
• Identify potential billing errors, fraud, or abuse.
• Prepare concise findings summaries and present outcomes clearly to internal partners.
• Track recurring issues to inform process improvements.
• Maintain organized records and documentation.

Skills

Attention to detail

Written and verbal communication

Microsoft Excel

Microsoft Word

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Coding Analyst to perform comprehensive medical claim reviews for waste and error, ensuring coding accuracy and proper documentation in accordance with state, CMS and company guidelines.

The role requires 2+ years in medical coding/auditing, CPC certification, and proficiency with CPT/HCPCS/ICD-10; neat attention to detail and strong communication are essential. Full-time position with a broad benefits package and a structured work environment.