Healthcare Audit & Compliance Specialist

NACBA; Northern (KY); Hybrid; USD 47,000 - 122,000; Full time

Benefits offered by this job

Comprehensive benefits

Paid time off

Retirement plan

Bonus eligibility

Job summary

CVS Health is seeking a Program Integrity Auditor to review medical records and ensure accurate coding and documentation across multiple lines of business, including Medicaid. The role involves identifying improper billing patterns and recommending corrective actions to prevent fraud, waste, or abuse.

Qualified candidates will have 3–5 years of experience in claims data review and medical record audits, with active CPC/CCS/CPMA credentials.

Qualifications

• 3–5 years of experience reviewing and interpreting claims data and medical records.
• 3–5 years of experience with CPT, HCPCS, ICD-10 coding guidelines.
• Active CPC, CCS, or CPMA license required.

Responsibilities

• Audit provider records across Medicaid and other lines of business to ensure compliant coding and documentation.
• Coordinate audit documentation and reports for internal/external stakeholders.
• Identify aberrant billing patterns and potential FWA; assist regulators with investigations.

Skills

Claims data review

CPT/HCPCS/ICD-10 coding

Auditing expertise

Education

Associate’s degree or equivalent

Job description

CVS Health is seeking a Program Integrity Auditor to review medical records and ensure accurate coding and documentation across multiple lines of business, including Medicaid. The role involves identifying improper billing patterns and recommending corrective actions to prevent fraud, waste, or abuse.

Qualified candidates will have 3–5 years of experience in claims data review and medical record audits, with active CPC/CCS/CPMA credentials.