Certified Medical Coding Auditor & Compliance Analyst

Internationalinsuranceprofessionals; Huntsville (AL); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance with CPT/HCPCS/ICD-10 guidelines. The role requires CPC certification, attention to detail, and experience with CMS/UB04 data elements, with opportunities to discuss findings with Medical Directors.

This full-time position offers a comprehensive benefits package, eligibility for bonus or incentive programs, and competitive compensation based on geography

Qualifications

• AAPC 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 knowledge.
• Keeps coding knowledge up to date with guidelines and reimbursement changes.
• Experience with researching coding and policies.
• Proficient with Microsoft Excel and Word.
• Strong written and verbal communication skills.

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS/billed modifiers match documentation.
• Research and apply CMS, state, and organizational guidelines during audits.
• Review cases with Medical Directors to validate decisions.
• Assist with investigations related to coding questions and policies.
• Identify potential billing errors, abuse, or fraud.
• Prepare clear, concise summaries of findings and rationale.
• Present outcomes to internal partners clearly.
• Track recurring coding and billing issues to inform improvements.
• Maintain proper records and documentation.

Skills

CPC Certification

Medical coding

Claims review

Auditing

CPT/HCPCS

ICD-10

CMS guidelines

Documentation

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance with CPT/HCPCS/ICD-10 guidelines. The role requires CPC certification, attention to detail, and experience with CMS/UB04 data elements, with opportunities to discuss findings with Medical Directors.

This full-time position offers a comprehensive benefits package, eligibility for bonus or incentive programs, and competitive compensation based on geography