Medical Coding Audit & Compliance Analyst

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

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding compliance across CPT/HCPCS, ICD-10, and modifiers. You will audit medical records, discuss cases with Medical Directors, and identify billing issues while maintaining documentation.

This full-time role requires CPC certification and 2+ years of coding experience, with strong knowledge of CMS/UB04 elements and proficient Excel/Word skills.

Qualifications

• CPC certification required.
• 2+ years of medical coding, claims review, auditing experience.
• Strong knowledge of CPT, HCPCS, ICD-10, and modifiers.
• CMS 1500 and UB04 data elements knowledge.
• Maintains up-to-date coding knowledge including changes to compliance and reimbursement.
• Experience researching coding and policies.
• Experience with Microsoft Excel and Word.
• Strong attention to detail and data interpretation.
• Excellent written and verbal communication skills.

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS/modifier consistency with documentation.
• Research and apply CMS/organizational guidelines related to audits with minimal support.
• Review and discuss cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse and fraud.
• Prepare clear findings summaries and present outcomes to internal partners.
• Track recurring coding and billing issues to inform process improvements.

Skills

CPC certification

Medical coding

Auditing experience

CPT/HCPCS/ICD-10

CMS 1500 UB04

Microsoft Excel/Word

Attention to detail

Communication skills

Education

AAPC CPC Certification

High School diploma or GED

Job description

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding compliance across CPT/HCPCS, ICD-10, and modifiers. You will audit medical records, discuss cases with Medical Directors, and identify billing issues while maintaining documentation.

This full-time role requires CPC certification and 2+ years of coding experience, with strong knowledge of CMS/UB04 elements and proficient Excel/Word skills.