Medicaid Program Integrity Auditor

NACBA; Kansas; On-site; USD 47,000 - 122,000; Full time

Benefits offered by this job

Healthcare

Paid time off

Retirement plan

Job summary

CVS Health is seeking a Program Integrity Auditor to review medical, behavioral health, transportation, and other provider records, ensuring correct coding and proper documentation across Medicaid and related lines of business, with a focus on reducing fraud, waste and abuse.

The role involves identifying aberrant billing patterns, preparing regulator reports, delivering provider education on coding rules, and partnering with audit teams to drive timely, compliant action and continuous process

Qualifications

• 3–5 years reviewing claims data and medical records.
• 3–5 years coding to CPT/HCPCS/ICD-10 guidelines.
• Active CPC/CCS/CPMA license.
• Arizona Time Zone availability (Mon-Fri 8am-5pm)

Responsibilities

• Audit records for Medicaid across multiple lines of business to ensure coding/documentation compliance.
• Review provider records for appropriate code usage, modifiers, and place of service.
• Coordinate audit reports for internal/external staff and regulators.
• Identify aberrant billing patterns and potential FWA; assist with investigations and regulator referrals.
• Provide training on regulatory requirements and coding rules; maintain policy compliance.

Skills

Claims data review

CPT/HCPCS/ICD-10

CPC CCS CPMA license

Regulatory standards

Education

Associate degree

Tools

QuickBase

Job description

CVS Health is seeking a Program Integrity Auditor to review medical, behavioral health, transportation, and other provider records, ensuring correct coding and proper documentation across Medicaid and related lines of business, with a focus on reducing fraud, waste and abuse.

The role involves identifying aberrant billing patterns, preparing regulator reports, delivering provider education on coding rules, and partnering with audit teams to drive timely, compliant action and continuous process