Certified Medical Coding Auditor & Compliance Analyst

Internationalinsuranceprofessionals; Naperville (IL); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Wellness programs

Job summary

CVS Health is seeking a Certified Coding Analyst to conduct comprehensive medical record audits, verify CPT/HCPCS and modifiers against documentation, and ensure compliance with state, CMS, and internal guidelines. The role requires 2+ years in coding, auditing, and review, with strong attention to detail and proven communication skills.

Responsibilities include presenting cases with clear rationale, tracking recurring issues, and maintaining detailed records.

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/UB04 data elements.

Responsibilities

• Perform comprehensive medical record audits to verify CPT/HCPCS and modifiers match documentation.
• Research state, CMS, and organizational guidelines related to audits with minimal support.
• Discuss cases with Medical Directors to validate decisions when needed.

Skills

Attention to detail

Written and verbal communication

Auditing

Education

AAPC CPC Certification

High School Diploma or GED

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Coding Analyst to conduct comprehensive medical record audits, verify CPT/HCPCS and modifiers against documentation, and ensure compliance with state, CMS, and internal guidelines. The role requires 2+ years in coding, auditing, and review, with strong attention to detail and proven communication skills.

Responsibilities include presenting cases with clear rationale, tracking recurring issues, and maintaining detailed records.