Expert Medical Coding Auditor for Compliance

Internationalinsuranceprofessionals; Columbus (OH); Hybrid; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error to ensure coding accuracy and compliance. You will audit CPT/HCPCS and modifiers against medical records, apply CMS/state guidelines, and discuss findings with Medical Directors as needed.

Responsibilities include identifying billing errors, preparing clear summaries, and supporting provider education. The role requires CPC certification, 2+ years coding experience, and proficiency with Excel

Qualifications

• 2+ years of experience in medical coding, claims review, auditing.
• Knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements.
• Maintains up-to-date coding knowledge including changes to coding compliance and reimbursement.
• Experience researching coding and policies.
• Experience with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS/modifier accuracy.
• Apply state, CMS and organizational guidelines related to audits.
• Review and discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud, and prepare clear summaries.
• Present outcomes and rationale clearly to internal partners.
• Track recurring coding issues to inform provider education.

Skills

CPC certification

Medical coding

Data interpretation

Communication skills

Excel

Word

Education

AAPC CPC certification

High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error to ensure coding accuracy and compliance. You will audit CPT/HCPCS and modifiers against medical records, apply CMS/state guidelines, and discuss findings with Medical Directors as needed.

Responsibilities include identifying billing errors, preparing clear summaries, and supporting provider education. The role requires CPC certification, 2+ years coding experience, and proficiency with Excel