Certified Medical Coding Auditor & Compliance Analyst

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

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation seeks a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance with CPT/HCPCS, ICD-10, and modifiers. The role involves audits of medical records, policy research, and collaboration with Medical Directors to validate decisions.

The Analyst will identify billing issues, prepare findings, and support provider education while maintaining thorough documentation. 40-hour weeks, full-time.

Qualifications

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

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS and modifiers align with documentation.
• Research CMS guidelines and organizational policies with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigations related to coding questions and policies.
• Identify potential billing errors, abuse and fraud.
• Prepare concise findings summaries.
• Present outcomes and rationale to internal partners clearly.
• Track recurring coding issues to inform process improvements.
• Maintain records and documentation.
• Follow workflows to meet production metrics.

Skills

CPC certification

2+ years experience

CPT/HCPCS/ICD-10 knowledge

CMS 1500 & UB04 data elements

Policy & coding research

Microsoft Excel

Microsoft Word

Communication skills

Education

AAPC CPC Certification

High School diploma or GED

Tools

Encoder Pro

Excel

Word

Job description

CVS Health Corporation seeks a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance with CPT/HCPCS, ICD-10, and modifiers. The role involves audits of medical records, policy research, and collaboration with Medical Directors to validate decisions.

The Analyst will identify billing issues, prepare findings, and support provider education while maintaining thorough documentation. 40-hour weeks, full-time.