Certified Medical Coding Auditor & Compliance Analyst

CVS Health Corporation; Little Rock (AR); 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 Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring compliance with CPT/HCPCS, ICD-10, and modifier guidelines. The role requires accuracy, strong documentation review, and the ability to work with medical directors.

This full-time position involves auditing state and federal requirements, identifying billing issues, and communicating findings clearly.

Qualifications

• AAPC CPC certification required.
• 2+ years of medical coding, claims review, auditing experience.
• Strong knowledge CPT/HCPCS/ICD-10 and modifiers.
• CMS 1500 and UB04 data elements familiarity.
• Proficient in Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS and modifiers align with documentation.
• Apply CMS/state guidelines to audits with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Prepare concise summaries of findings and present outcomes clearly.

Skills

CPC Certification

Medical coding

Claims review

Auditing

Attention to detail

Verbal communication

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Encoder Pro

Job description

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring compliance with CPT/HCPCS, ICD-10, and modifier guidelines. The role requires accuracy, strong documentation review, and the ability to work with medical directors.

This full-time position involves auditing state and federal requirements, identifying billing issues, and communicating findings clearly.