Medical Coding Audit Specialist - Compliance & Quality

CVS Health Corporation

Santa Fe (NM)

On-site

USD 44,000 - 102,000

Full time

4 days ago

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Job summary

CVS Health seeks a Certified Coding Analyst to perform detailed medical record reviews ensuring CPT/HCPCS/ICD-10 coding aligns with documentation and policy. You will audit codes, discuss cases with Medical Directors, and identify potential billing errors for process improvements.

The role requires strong attention to detail, CPC certification, and 2+ years of related experience. This is a full-time position with standard 40-hour weeks and a pay range reflecting geography and experience, plus

Qualifications

CPC certification required for role.
2+ years of medical coding, claims review or auditing experience.
Knowledge of CPT, HCPCS, ICD-10, and modifiers essential.
Familiarity with CMS 1500 and UB04 elements.
Maintain up-to-date coding knowledge and guidelines.
Experience researching coding policies and guidelines.
Proficient with Microsoft Excel and Word.

Responsibilities

Perform comprehensive medical record audits to verify CPT/HCPCS/modifier accuracy.
Research and apply state, CMS and organizational guidelines to audits.
Discuss cases with Medical Directors to validate decisions.
Identify potential billing errors, waste, or fraud during reviews.
Prepare clear summaries of findings and rationale for internal partners.
Track recurring coding issues to inform process improvements.