Certified Professional Coder — Medical Claims Auditor

Hispanic Alliance for Career Enhancement; Oklahoma; Hybrid; USD 43,888 - 93,574; Full time

Job summary

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit. You will audit medical records for CPT/HCPCS/ICD-10 compliance, prepare written findings, and communicate results to investigators and leadership.

You will research CMS guidelines, identify billing irregularities, and maintain proper documentation. The role requires 3+ years of coding/auditing experience, CPC certification, and proficiency with Excel and Word.

Qualifications

• 3+ years of experience in medical coding or documentation auditing.
• AAPC CPC Certification required; knowledge of CPT/HCPCS/ICD-10.
• Proficiency with Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to verify coding against documentation.
• Provide detailed written summaries of findings.
• Articulate findings to investigators, leadership, and regulators.
• Research state and CMS guidelines related to audits.
• Identify potential billing errors, abuse, and fraud.
• Maintain accurate records and meet performance metrics.

Skills

CPC Certification

Medical coding

Documentation auditing

Attention to detail

Education

GED or equivalent

CPC Certification

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit. You will audit medical records for CPT/HCPCS/ICD-10 compliance, prepare written findings, and communicate results to investigators and leadership.

You will research CMS guidelines, identify billing irregularities, and maintain proper documentation. The role requires 3+ years of coding/auditing experience, CPC certification, and proficiency with Excel and Word.