Certified Medical Coding Auditor & Claims Reviewer

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

Job summary

CVS Health Corporation in Phoenix, AZ, seeks a Certified Coding Analyst to audit medical records for correct CPT/HCPCS coding and ensure compliance with state and CMS guidelines.

The role requires CPC certification, 2+ years coding experience, strong attention to detail, and the ability to present findings to Medical Directors; the position offers a full-time schedule and comprehensive benefits.

Qualifications

• AAPC CPC certification and up-to-date coding knowledge.
• 2+ years in medical coding, claims review, or auditing.
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers.
• Experience with CMS 1500 and UB04 data elements.
• Proficient in Excel and Word; detail-oriented.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS coding.
• Apply CMS and organizational guidelines to audits with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Prepare concise findings and present outcomes to internal partners.
• Track recurring coding issues to inform process improvements.
• Maintain records and support daily workflows.

Skills

CPC certification

Medical coding

Data interpretation

Excel

Communication skills

Education

AAPC CPC Certification

High School Diploma

Tools

EncoderPro

MS Word

Job description

CVS Health Corporation in Phoenix, AZ, seeks a Certified Coding Analyst to audit medical records for correct CPT/HCPCS coding and ensure compliance with state and CMS guidelines.

The role requires CPC certification, 2+ years coding experience, strong attention to detail, and the ability to present findings to Medical Directors; the position offers a full-time schedule and comprehensive benefits.