Healthcare Coding Audit Specialist

CVS Health Corporation; Pierre (SD); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus program

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance. In this full-time role, you will audit CPT/HCPCS, ICD-10, and modifiers across medical records, coordinate with Medical Directors, and support provider education and process improvements.

Ideal candidates hold CPC certification, have 2+ years of coding/auditing experience, and demonstrate strong analytical and communication skills.

Qualifications

• AAPC CPC certification required.
• 2+ years of medical coding, claims review, auditing experience.
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS and modifiers align with documentation.
• Research and apply state, CMS and organizational guidelines for audits.
• Review cases with Medical Directors to validate decisions as needed.
• Identify billing errors, abuse, and fraud; document findings clearly.

Skills

CPC Certification

Medical coding

Auditing

CMS guidelines

Excel

Education

High School diploma or GED

Tools

Microsoft Excel

MS Word

Job description

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance. In this full-time role, you will audit CPT/HCPCS, ICD-10, and modifiers across medical records, coordinate with Medical Directors, and support provider education and process improvements.

Ideal candidates hold CPC certification, have 2+ years of coding/auditing experience, and demonstrate strong analytical and communication skills.