CPC Auditor: Medical Coding Compliance & Audits

CVS Health; Austin (TX); On-site; USD 43,888 - 93,574; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Job summary

CVS Health in Austin, TX is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. You will audit medical records for CPT/HCPCS accuracy and ensure documentation supports billing, with focus on compliance and potential fraud detection.

The role requires CPC certification, 3+ years in medical coding or auditing, strong attention to detail, and solid communication skills to convey findings to investigators and regulators.

Qualifications

• 3+ years of experience in medical coding or documentation auditing.
• Knowledge of CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements.
• Experience with researching coding and policies.

Responsibilities

• Conduct a comprehensive medical record audit to ensure CPT/HCPCS or modifiers billed are consistent with documentation.
• Provide detailed written summary of medical record review findings.
• Articulate findings to investigators, Medicaid plan leadership, law enforcement, and others as needed.
• Research and apply state or CMS guidelines related to audits with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud; identify savings opportunities.

Skills

Attention to detail

Communication skills

Analytical skills

Researching coding/policies

Behavioral Health coding experience

Education

GED or equivalent

AAPC CPC Certification

Tools

Excel

Word

Job description

CVS Health in Austin, TX is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. You will audit medical records for CPT/HCPCS accuracy and ensure documentation supports billing, with focus on compliance and potential fraud detection.

The role requires CPC certification, 3+ years in medical coding or auditing, strong attention to detail, and solid communication skills to convey findings to investigators and regulators.