Medicaid Program Integrity Auditor: Claims & Compliance

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

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Programs Integrity Auditor to review medical, behavioral, and other provider records, ensuring accurate coding and documentation, identifying potential FWA and regulatory concerns. This full-time role requires 3–5 years of claims data review and coding experience with CPC/CCS/CPMA credentials.

The position offers a comprehensive benefits package, including medical, dental, vision, paid time off, and retirement options, with standard business hours and a collaborative team

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.
• Active CPC, CCS, or CPMA license.
• Willingness to work Monday-Friday from 8am-5pm Arizona Time Zone.

Responsibilities

• Audit provider records to ensure coding and documentation meet regulatory standards.
• Coordinate audit documentation and reports for internal and external staff and stakeholders.
• Identify aberrant billing patterns and potential FWA; report to regulators as needed.
• Assist with development and implementation of FWA avoidance, detection, and referral.
• Provide training on regulatory requirements and coding rules.
• Maintain compliance with company policies and procedures.
• Perform other duties as assigned.

Skills

Claims data review

Medical records interpretation

CPT coding

HCPCS coding

ICD-10 coding

Regulatory compliance

Audit

Education

Associate's degree

Tools

QuickBase

Job description

CVS Health is seeking a Programs Integrity Auditor to review medical, behavioral, and other provider records, ensuring accurate coding and documentation, identifying potential FWA and regulatory concerns. This full-time role requires 3–5 years of claims data review and coding experience with CPC/CCS/CPMA credentials.

The position offers a comprehensive benefits package, including medical, dental, vision, paid time off, and retirement options, with standard business hours and a collaborative team