Healthcare Compliance & Audit Specialist

NACBA; Kentucky; Hybrid; USD 47,000 - 122,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is hiring a Program Integrity Auditor to review medical and provider records, ensuring accurate coding and compliant documentation. You will audit multiple lines of business and identify potential fraud, with responsibilities spanning education, regulatory adherence, and regulator referrals.

The role requires CPC/CCS/CPMA certification, 3–5 years in claims/data review, and the ability to work 8am–5pm Arizona time. Join a team focused on safety, quality, and accountability.

Qualifications

• 3–5 years of experience reviewing and interpreting claims data and medical records.
• 3–5 years of experience with CPT, HCPCS, and ICD-10 coding.
• Available to work Monday–Friday 8am–5pm Arizona Time.
• Active CPC, CCS, or CPMA certification.

Responsibilities

• Audit records for regulatory coding and documentation to ensure standards.
• Coordinate audit documentation and reports for internal and external staff.
• Identify aberrant billing patterns and report suspected FWA.
• Assist with FWA avoidance, detection and referral.
• Provide education on regulatory requirements and coding rules.
• Maintain compliance with company policies and procedures.
• Perform other duties as assigned.

Skills

Claims data review

Medical records review

CPT/HCPCS/ICD-10 coding

CPC/CCS/CPMA certification

Education

Associate's degree

Tools

QuickBase

Job description

CVS Health is hiring a Program Integrity Auditor to review medical and provider records, ensuring accurate coding and compliant documentation. You will audit multiple lines of business and identify potential fraud, with responsibilities spanning education, regulatory adherence, and regulator referrals.

The role requires CPC/CCS/CPMA certification, 3–5 years in claims/data review, and the ability to work 8am–5pm Arizona time. Join a team focused on safety, quality, and accountability.