Health Program Integrity Auditor: Code & Compliance Expert

CVS Health Corporation; Louisiana (MO); Hybrid; USD 47,000 - 122,000; Full time

Benefits offered by this job

Medical, dental, vision

Paid time off

Retirement savings options

Bonus eligibility

Job summary

CVS Health Corporation is seeking a Program Integrity Auditor to review medical, behavioral, transportation and other healthcare provider records, ensuring correct coding and documentation and adherence to regulatory standards.

You will audit records across Medicaid lines, identify aberrant billing patterns, and advise on education, recoupment, or referrals to state regulators. This full‑time role offers a comprehensive benefits package and a base pay range of $46,988 to $122,400.

Qualifications

• 3–5 years of experience reviewing and interpreting claims data and medical records.
• Experience with CPT, HCPCS, and ICD-10 coding guidelines.
• Active CPC, CCS, or CPMA license.
• Arizona Time Zone, Mon–Fri, 8am–5pm work hours.

Responsibilities

• Audit records for Medicaid and other lines of business to ensure coding accuracy and documentation standards.
• Coordinate audit documentation and reports for internal and external stakeholders.
• Identify aberrant billing patterns and potential FWA, reporting to regulators as needed.
• Assist with development of plans for FWA avoidance, detection and referral.
• Provide training on regulatory requirements and coding rules.

Skills

Claims data review

Medical records review

CPT/HCPCS/ICD-10 coding

Regulatory compliance

Education

Associate’s degree

Job description

CVS Health Corporation is seeking a Program Integrity Auditor to review medical, behavioral, transportation and other healthcare provider records, ensuring correct coding and documentation and adherence to regulatory standards.

You will audit records across Medicaid lines, identify aberrant billing patterns, and advise on education, recoupment, or referrals to state regulators. This full‑time role offers a comprehensive benefits package and a base pay range of $46,988 to $122,400.