Medical Coding Audit & Compliance Analyst

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

Benefits offered by this job

Health insurance

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliant documentation across medical and institutional providers.

You will audit CPT/HCPCS, ICD-10 and modifiers, partner with Medical Directors, identify billing issues, and contribute to provider education while meeting production metrics in a full-time Sacramento area role.

Qualifications

• Certified Professional Coder with CPC credential.
• 2+ years in medical coding, claims review or auditing.
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers.
• familiarity with CMS 1500 and UB04 data elements.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS or modifiers align with documentation.
• Apply state, CMS, and organizational guidelines in audits with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with coding policy investigations and education.
• Identify potential billing errors, abuse, and fraud.
• Prepare clear summaries of findings and present outcomes to partners.
• Track recurring coding issues to drive process improvements.
• Maintain organized records and files.

Skills

CPC certification

Medical coding

CPT/HCPCS/ICD-10

CMS 1500/UB04

Excel

Written and verbal communication

Attention to detail

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Job description

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliant documentation across medical and institutional providers.

You will audit CPT/HCPCS, ICD-10 and modifiers, partner with Medical Directors, identify billing issues, and contribute to provider education while meeting production metrics in a full-time Sacramento area role.