Certified Medical Coding Auditor – Compliance & QA

CVS Health Corporation; Des Moines (IA); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Paid time off

Job summary

CVS Health is seeking a Certified Coding Analyst to perform comprehensive medical claim reviews for waste and error, ensuring coding practices align with CPT/HCPCS, ICD-10, and CMS guidelines.

The role involves auditing records, researching policies, discussing cases with Medical Directors, and identifying potential billing issues. Strong communication and documentation skills are essential for success.

Qualifications

• AAPC CPC certification required.
• 2+ years in medical coding, claims review, auditing.
• Knowledge of CPT, HCPCS, ICD-10 and modifiers.
• Experience with CMS 1500 and UB04 data elements.
• Proficiency in Excel and Word.

Responsibilities

• Audit medical records to verify CPT/HCPCS/Modifiers with documentation.
• Research state, CMS and internal guidelines for audits.
• Discuss cases with Medical Directors to validate decisions.
• Identify billing errors, potential fraud, abuse or waste.
• Prepare concise summaries of findings and present rationale.

Skills

Attention to detail

Written communication

Verbal communication

Education

High School diploma or GED

AAPC CPC Certification

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Coding Analyst to perform comprehensive medical claim reviews for waste and error, ensuring coding practices align with CPT/HCPCS, ICD-10, and CMS guidelines.

The role involves auditing records, researching policies, discussing cases with Medical Directors, and identifying potential billing issues. Strong communication and documentation skills are essential for success.