Certified Medical Coding Auditor & Compliance Analyst

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

Job summary

CVS Health Corporation seeks a Certified Coding Analyst to audit medical records and ensure CPT/HCPCS alignment with documentation. You will research CMS and company policies, discuss findings with Medical Directors, and help identify billing errors or fraud.

Strong Excel/Word skills, attention to detail, and clear communication are essential. The role focuses on producing accurate analysis, maintaining records, and supporting production metrics in a full-time, on-site capacity at CVS Health

Qualifications

• AAPC CPC certification required and up-to-date.
• 2+ years in medical coding, claims review, auditing.
• Strong knowledge of CPT, HCPCS, ICD-10, and modifiers.
• Experience with CMS 1500 and UB04 data elements.
• Maintains up-to-date coding knowledge and policy research.
• Proficiency with Microsoft Excel and Word.
• Strong attention to detail and data interpretation.
• Clear written and verbal communication skills.

Responsibilities

• Perform comprehensive medical record audits to verify CPT/HCPCS and modifiers match documentation.
• Research state, CMS and organizational guidelines with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Prepare concise summaries of findings and present outcomes to internal partners.
• Track recurring coding issues to inform process improvements.
• Maintain records and follow workflows to meet production metrics.

Skills

CPC Certification

Medical coding

Coding guidelines

CMS 1500 UB04

Excel

Word

Attention to detail

Communication

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Job description

CVS Health Corporation seeks a Certified Coding Analyst to audit medical records and ensure CPT/HCPCS alignment with documentation. You will research CMS and company policies, discuss findings with Medical Directors, and help identify billing errors or fraud.

Strong Excel/Word skills, attention to detail, and clear communication are essential. The role focuses on producing accurate analysis, maintaining records, and supporting production metrics in a full-time, on-site capacity at CVS Health