Healthcare Audit & Compliance Specialist

NACBA; Rhode Island; On-site; USD 47,000 - 122,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Program Integrity Auditor to review medical, behavioral, transportation, and other provider records to ensure proper coding and documentation. The role involves identifying FWA indicators, recommending follow-up actions, and collaborating with regulators as needed.

The ideal candidate holds an active CPC, CCS, or CPMA license, has 3–5 years of claims data review experience, and is comfortable working 8am–5pm in the applicable time zone.

Qualifications

• 3-5 years of experience in reviewing and interpreting claims data and medical records.

Responsibilities

• Audit provider records to ensure coding and documentation meet regulatory standards.

Skills

Analytical thinking

Attention to detail

Communication skills

Presentation skills

Education

Associate's degree or equivalent experience

Tools

QuickBase

Job description

CVS Health is seeking a Program Integrity Auditor to review medical, behavioral, transportation, and other provider records to ensure proper coding and documentation. The role involves identifying FWA indicators, recommending follow-up actions, and collaborating with regulators as needed.

The ideal candidate holds an active CPC, CCS, or CPMA license, has 3–5 years of claims data review experience, and is comfortable working 8am–5pm in the applicable time zone.