Certified Medical Coding Auditor — Compliance & Quality

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Indianapolis is seeking a Certified Coding Analyst to perform medical claim reviews for compliance with coding practices. The Analyst must determine correct coding and documentation during record reviews and ensure state, federal and company requirements are met.

Responsibilities include auditing CPT/HCPCS and modifiers, applying CMS and organizational guidelines, discussing cases with Medical Directors, investigating coding questions, and highlighting potential billing errors for

Qualifications

• AAPC CPC certification is required.
• 2+ years of experience 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, including policy changes.
• Experience researching coding guidelines and policies.
• Proficiency with Microsoft Excel and Word.

Responsibilities

• Perform comprehensive medical record audits to ensure coded items match documentation.
• Research state, CMS and organizational guidelines related to audits.
• Review cases with Medical Directors to validate decisions.
• Identify billing errors, abuse, and fraud and document findings clearly.
• Present outcomes and rationale to internal partners concisely.
• Track recurring coding issues to inform process improvements.

Skills

Attention to detail

Written communication

Verbal communication

Analytical problem solving

Education

High School diploma or GED

AAPC CPC Certification

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health in Indianapolis is seeking a Certified Coding Analyst to perform medical claim reviews for compliance with coding practices. The Analyst must determine correct coding and documentation during record reviews and ensure state, federal and company requirements are met.

Responsibilities include auditing CPT/HCPCS and modifiers, applying CMS and organizational guidelines, discussing cases with Medical Directors, investigating coding questions, and highlighting potential billing errors for