CPC-Certified Medical Coding Auditor

CVS Health Corporation; Tallahassee (FL); 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 is hiring a Certified Coding Analyst to perform medical claim reviews and audits, ensuring coding accuracy and compliance with CPT/HCPCS, ICD-10, and CMS guidelines. You will review medical records, discuss findings with Medical Directors, and identify potential billing issues.

The role requires CPC certification, 2+ years in coding/review, and strong Excel/Word skills with precise written and verbal communication. Full-time employment with comprehensive benefits.

Qualifications

• Requires CPC certification and continuing coding education.
• 2+ years of experience in medical coding, claims review, auditing.
• Solid knowledge of CPT, HCPCS, ICD-10 and modifiers.
• Familiarity with CMS 1500 and UB04 data elements.
• Maintains up-to-date coding knowledge including changes in policies.
• Experience researching coding and policies.
• Proficiency with Microsoft 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 and modifiers align with documentation.
• Research state, CMS and organizational guidelines related to audits.
• Discuss cases with Medical Directors to validate decisions.
• Investigate coding questions and relevant policies.
• Identify potential billing errors, abuse and fraud.
• Prepare clear summaries of findings and rationale.
• Present cases and decisions to internal partners clearly.
• Track recurring coding issues to inform improvements.
• Maintain records and documentation; follow workflows to meet production metrics.

Skills

Attention to detail

Communication skills

Researching coding and policies

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Encoder Pro

Job description

CVS Health is hiring a Certified Coding Analyst to perform medical claim reviews and audits, ensuring coding accuracy and compliance with CPT/HCPCS, ICD-10, and CMS guidelines. You will review medical records, discuss findings with Medical Directors, and identify potential billing issues.

The role requires CPC certification, 2+ years in coding/review, and strong Excel/Word skills with precise written and verbal communication. Full-time employment with comprehensive benefits.