CPC-Certified Medical Coding Audit Specialist

Internationalinsuranceprofessionals; Raleigh (NC); On-site; USD 44,000 - 102,000; Full time

Job summary

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance with CPT/HCPCS, ICD-10, modifiers and CMS guidelines across medical and institutional providers.

You will audit records, discuss cases with Medical Directors, identify billing issues, and prepare concise findings while maintaining documentation and contributing to process improvements.

Qualifications

• AAPC CPC certification required.
• 2+ years of medical coding, claims review or auditing experience.
• Knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements knowledge.
• Proficiency with Excel and Word.
• Strong attention to detail and data interpretation.
• Excellent written and verbal communication skills.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS modifiers align with documentation.
• Research and apply state, CMS and organizational guidelines with minimal support.
• Discuss cases with Medical Directors to validate decisions as needed.
• Assist with coding-related investigative research.
• Identify potential billing errors, abuse and fraud.
• Prepare clear, concise summaries of findings.
• Present case outcomes and rationale to internal partners clearly.
• Track recurring coding issues to inform improvements and training.
• Maintain thorough records and documentation.
• Follow workflows to meet production metrics.

Skills

Attention to detail

Strong communication

Policy research

Data interpretation

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Encoder Pro

Job description

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance with CPT/HCPCS, ICD-10, modifiers and CMS guidelines across medical and institutional providers.

You will audit records, discuss cases with Medical Directors, identify billing issues, and prepare concise findings while maintaining documentation and contributing to process improvements.