Certified Medical Coding Auditor - Compliance & Fraud

DaMar Staffing; Jefferson City (MO); On-site; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for its Special Investigations Unit to conduct medical claim reviews, ensure coding accuracy, and uphold state, federal, and company guidelines across medical, behavioral, transportation and other services.

You will present findings to investigators and leadership, audit records for CPT/HCPCS codes, identify billing errors and fraud, and help drive savings while maintaining up-to-date coding knowledge.

Qualifications

• AAPC CPC certification required.
• At least 3 years of medical coding or documentation auditing experience.
• Knowledge of CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements.
• Experience researching coding and policies.
• Proficiency with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS or modifiers billed align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Apply state or CMS guidelines to audits with minimal guidance.
• 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.
• Identify opportunities for savings in prepayment reviews.
• Maintain records and documentation.
• Keep up-to-date coding knowledge and changes to compliance and reimbursement.

Skills

CPC certification

3+ years experience

CPT/HCPCS/ICD-10 knowledge

Researching coding policies

Excel proficiency

Education

AAPC CPC certification

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) for its Special Investigations Unit to conduct medical claim reviews, ensure coding accuracy, and uphold state, federal, and company guidelines across medical, behavioral, transportation and other services.

You will present findings to investigators and leadership, audit records for CPT/HCPCS codes, identify billing errors and fraud, and help drive savings while maintaining up-to-date coding knowledge.