Healthcare Program Integrity Auditor

NACBA; South Dakota; Hybrid; USD 47,000 - 122,000; Full time

Job summary

CVS Health is hiring a Program Integrity Auditor to review medical, behavioral, transportation, and other provider records and ensure accurate coding and documentation. You will identify irregular billing patterns, recommend follow-up actions, and support regulator submissions.

The role requires 3–5 years in claims data review, CPT/HCPCS/ICD-10 expertise, and an active CPC/CCS/CPMA license. Typical hours are Mon-Fri 8am-5pm Arizona Time, base pay range disclosed, full-time with benefits.

Qualifications

• 3-5 years reviewing and interpreting claims data and medical records.
• 3-5 years with CPT/HCPCS/ICD-10 coding guidelines.
• Active CPC, CCS or CPMA license.
• Willingness to work Monday-Friday 8am-5pm Arizona Time.
• Associate degree or equivalent experience.

Responsibilities

• Audit records for Medicaid across multiple lines of business.
• Ensure coding and documentation meet regulatory standards.
• Coordinate audit documentation and reports for internal and external staff.
• Identify aberrant billing patterns and potential FWA and report to regulators.
• Assist with development of FWA avoidance and regulator deliverables.
• Provide technical assistance and education to providers on regulatory requirements.
• Maintain compliance with company policies and procedures.
• Perform other duties as assigned.

Skills

Claims data review

Medical records interpretation

CPT/HCPCS/ICD-10 coding

Licensure: CPC/CCS/CPMA

Arizona time availability

Education

Associate degree or equivalent experience

Job description

CVS Health is hiring a Program Integrity Auditor to review medical, behavioral, transportation, and other provider records and ensure accurate coding and documentation. You will identify irregular billing patterns, recommend follow-up actions, and support regulator submissions.

The role requires 3–5 years in claims data review, CPT/HCPCS/ICD-10 expertise, and an active CPC/CCS/CPMA license. Typical hours are Mon-Fri 8am-5pm Arizona Time, base pay range disclosed, full-time with benefits.