Medical Coding Audit Specialist

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

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Wellbeing programs

Job summary

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error to ensure compliance with coding practices through a comprehensive record review for medical and institutional providers.

The Analyst will determine correct coding and documentation during reviews, ensure state, federal and company requirements are met, and contribute to process improvements and provider education.

Qualifications

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

Responsibilities

• Conduct a comprehensive medical record audit to ensure CPT/HCPCS or modifiers billed are consistent with documentation.
• Research and apply state, CMS and organizational guidelines related to the audit.
• Review cases with Medical Directors to validate decisions as needed.
• Assist with investigative research related to coding questions, state and federal policies.
• Identify potential billing errors, abuse, and fraud.
• Prepare clear, concise summary of findings.
• Present case outcomes and rationale to internal partners.
• Track recurring coding and billing issues to inform process improvements.
• Maintain records and documentation.
• Uses department resources regularly.
• Follows workflows with minimal assistance to meet production metrics.

Skills

Attention to detail

Written communication

Verbal communication

Analytical thinking

Problem solving

Education

AAPC CPC certification

High School diploma or GED

Tools

Excel

Word

Encoder pro

Job description

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error to ensure compliance with coding practices through a comprehensive record review for medical and institutional providers.

The Analyst will determine correct coding and documentation during reviews, ensure state, federal and company requirements are met, and contribute to process improvements and provider education.