Certified Medical Coding Auditor for Compliance

Internationalinsuranceprofessionals; Columbia (SC); On-site; USD 44,000 - 102,000; Full time

Job summary

CVS Health seeks a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding compliance through comprehensive record reviews of medical and institutional providers.

The analyst will determine correct coding and documentation, review state and federal requirements, and present findings with clear rationale to internal partners. 40-hour workweeks, full-time, with a comprehensive benefits package.

Qualifications

• 2+ years of medical coding, claims review or auditing experience.
• Knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements.
• Proficient with Microsoft Office products.
• Strong attention to detail and written/verbal communication skills.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS/modifier accuracy against documentation.
• Research and apply CMS/state guidelines relevant to audits with minimal supervision.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, waste, abuse and fraud; document findings clearly.
• Track recurring coding issues to inform process improvements and provider education.
• Maintain organized records and comply with department workflows to meet production metrics.

Skills

Medical coding

Auditing

Data interpretation

Documentation review

Communication

Education

AAPC CPC Certification

High School diploma or GED

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health seeks a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding compliance through comprehensive record reviews of medical and institutional providers.

The analyst will determine correct coding and documentation, review state and federal requirements, and present findings with clear rationale to internal partners. 40-hour workweeks, full-time, with a comprehensive benefits package.