Medical Coding Audit & Compliance Analyst

CVS Health Corporation; Boise (ID); On-site; USD 44,000 - 102,000; Full time

Job summary

CVS Health is seeking a Certified Coding Analyst to perform comprehensive medical record audits, ensuring CPT/HCPCS or modifiers billed match the documentation and comply with state, CMS and company guidelines. The role requires analytical review, attention to detail, and clear communication with Medical Directors.

Responsibilities include investigating coding questions, identifying billing errors or potential fraud, and preparing concise findings with rationale for internal partners while

Qualifications

• AAPC CPC certification required or current certification.
• 2+ years of experience in medical coding, claims review, auditing.
• Knowledge of CPT, HCPCS, ICD-10 and modifiers.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS or modifiers billed align with documentation.
• Research CMS and organizational guidelines related to audits with minimal support.
• Review cases with Medical Directors to validate decisions as needed.
• Identify potential billing errors, abuse and fraud.
• Prepare concise findings summaries and present outcomes to internal partners.

Skills

Attention to detail

Auditing

Verbal and written communication

Medical coding knowledge

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Coding Analyst to perform comprehensive medical record audits, ensuring CPT/HCPCS or modifiers billed match the documentation and comply with state, CMS and company guidelines. The role requires analytical review, attention to detail, and clear communication with Medical Directors.

Responsibilities include investigating coding questions, identifying billing errors or potential fraud, and preparing concise findings with rationale for internal partners while