Medicaid Program Integrity Auditor

NACBA

Town of Texas (WI)

Hybrid

USD 47,000 - 122,000

Full time

9 days ago

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Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Program Integrity Auditor to review medical, behavioral, transportation, and other provider records for accurate coding and documentation. You will identify aberrant billing patterns, advise on follow-up actions, and help regulators when needed.

The role emphasizes compliance with state and federal requirements and collaborative work with internal teams. Qualifications include 3–5 years in claims data and medical record reviews, CPT/HCPCS/ICD-10 knowledge, and an active

Qualifications

3-5 years of experience in reviewing and interpreting claims data and medical records.
Knowledge of CPT, HCPCS, and ICD-10 coding guidelines.
Active CPC, CCS, or CPMA license required.

Responsibilities

Audit records for multiple lines of business to ensure coding and documentation meet regulatory standards.
Coordinate audit documentation and reports for internal and external stakeholders.
Identify aberrant billing patterns and report to internal staff and regulators as needed.
Assist with development and implementation of FWA avoidance, detection and referral strategies.
Provide training on regulatory requirements, coding and documentation rules.