Healthcare Coding Audit Specialist (CPC)

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

Benefits offered by this job

Medical, dental, and vision coverage

Retirement savings options

Paid time off

Job summary

CVS Health Corporation seeks a Certified Coding Analyst to review medical claims for waste and error, ensuring compliance with coding practices through meticulous record reviews. You will validate CPT/HCPCS usage and modifiers, while ensuring state and federal guidelines are met.

Strong communication and detailed documentation are essential. The role involves auditing, researching policies, and collaborating with Medical Directors to validate decisions.

Qualifications

• AAPC CPC certification and 2+ years in medical coding, claims review or auditing.
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements; up-to-date coding knowledge.

Responsibilities

• Conduct comprehensive medical record audits for CPT/HCPCS and modifiers.
• Research CMS and organizational guidelines related to audits.
• Identify billing errors, prepare clear findings, and present rationale.

Skills

CPC certification

Medical coding

Claims review

Auditing

Attention to detail

Verbal and written communication

Microsoft Excel

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Job description

CVS Health Corporation seeks a Certified Coding Analyst to review medical claims for waste and error, ensuring compliance with coding practices through meticulous record reviews. You will validate CPT/HCPCS usage and modifiers, while ensuring state and federal guidelines are met.

Strong communication and detailed documentation are essential. The role involves auditing, researching policies, and collaborating with Medical Directors to validate decisions.