Certified Medical Coding Auditor & Compliance Analyst

4062 Aetna Resources, LLC; Connecticut; 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

Job summary

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews and comprehensive record audits to ensure CPT/HCPCS alignment with documentation and CMS guidelines.

The role requires CPC certification, 2+ years in coding/claims review, and strong analytical and communication skills. The position includes a competitive benefits package and opportunities to impact provider education and process improvements in a full-time on-site capacity.

Qualifications

• AAPC Certified Professional Coder (CPC) certification required.
• 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.
• Maintains up-to-date coding knowledge and policies.
• Experience with researching coding and policies.
• Proficiency with Microsoft Excel and Word.
• Strong attention to detail and data interpretation.
• Excellent written and verbal communication skills.

Responsibilities

• Perform medical claim reviews for waste and error to ensure coding compliance.
• Conduct comprehensive medical record audits to ensure CPT/HCPCS or modifiers align with documentation.
• Apply state, CMS and organizational guidelines during audits.
• Discuss cases with Medical Directors to validate decisions.
• Assist with research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud; prepare clear summaries of findings.
• Track recurring coding issues to inform process improvements and provider education.
• Follow workflows to meet production metrics.

Skills

CPC certification

Medical coding

CMS guidelines

ICD-10

CPT/HCPCS

Documentation review

Excel

Word

Attention to detail

Communication skills

Education

CPC certification

High School diploma or GED

Tools

EncoderPro

Job description

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews and comprehensive record audits to ensure CPT/HCPCS alignment with documentation and CMS guidelines.

The role requires CPC certification, 2+ years in coding/claims review, and strong analytical and communication skills. The position includes a competitive benefits package and opportunities to impact provider education and process improvements in a full-time on-site capacity.