Impactful Medical Coding Auditor — Compliance & Quality

CVSHealth; Hartford (CT); On-site; USD 61,000 - 102,000; Full time

Job summary

CVS Health in Hartford, CT is seeking a Certified Coding Analyst to perform medical claim reviews, ensure CPT/HCPCS alignment, and verify documentation for compliance across state and federal guidelines.

You will audit medical records, apply CMS and payer guidelines, discuss cases with Medical Directors, and help identify billing errors and opportunities for process improvements.

This full-time role offers a competitive benefits package and a pathway to contribute to a large health care network.

Qualifications

• AAPC CPC certification is required.
• 2+ years in medical coding, claims review, or auditing.
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements familiar.
• Maintains up-to-date coding knowledge and policies.
• Experience with researching coding and policies.
• Proficient with Microsoft Excel and Word.
• Strong attention to detail and data interpretation.
• Excellent written and verbal communication.

Responsibilities

• Conduct comprehensive medical record audits for CPT/HCPCS accuracy.
• Apply CMS and state guidelines with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with investigations related to coding questions and policies.
• Identify potential billing errors, abuse and fraud.
• Prepare clear summaries of findings.
• Present outcomes and rationale to internal partners.
• Track recurring coding issues to drive process improvements.
• Maintain organized records and documentation.
• Follow workflows to meet daily production metrics.

Skills

Attention to detail

Communication skills

Policy research

Education

CPC Certification

High School diploma

Tools

Excel

Word

Job description

CVS Health in Hartford, CT is seeking a Certified Coding Analyst to perform medical claim reviews, ensure CPT/HCPCS alignment, and verify documentation for compliance across state and federal guidelines.

You will audit medical records, apply CMS and payer guidelines, discuss cases with Medical Directors, and help identify billing errors and opportunities for process improvements.

This full-time role offers a competitive benefits package and a pathway to contribute to a large health care network.