Medical Coding Audit Specialist: Precision & Compliance

CVS Health Corporation; Columbia (SC); 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 Corporation is seeking a Certified Coding Analyst to perform comprehensive medical claim reviews and audits, ensuring coding accuracy and compliant documentation. The role requires CPC certification, CPT/HCPCS/ICD-10 knowledge, and strong analytical skills.

You will interact with Medical Directors and participate in process improvements and provider education. The position emphasizes accuracy, collaboration, and adherence to CMS/state guidelines, with full-time hours and benefits

Qualifications

• AAPC CPC certification held; coding knowledge met.
• Experience with CPT/HCPCS/ICD-10 and modifiers required.
• Familiarity with CMS 1500 and UB04 data elements.

Responsibilities

• Perform comprehensive medical record audits to ensure CPT/HCPCS or modifiers billed align with documentation.
• Research and apply state, CMS and organizational guidelines during audits with minimal support.
• Review and discuss cases with Medical Directors to validate decisions as needed.
• Identify potential billing errors, abuse, and fraud; assist with investigations as required.
• Prepare clear summaries of findings and present outcomes to internal partners.

Skills

AAPC CPC certification

Medical coding experience

CPT/HCPCS/ICD-10 knowledge

CMS 1500/UB04 data elements

Excel

Word

Attention to detail

Communication skills

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 comprehensive medical claim reviews and audits, ensuring coding accuracy and compliant documentation. The role requires CPC certification, CPT/HCPCS/ICD-10 knowledge, and strong analytical skills.

You will interact with Medical Directors and participate in process improvements and provider education. The position emphasizes accuracy, collaboration, and adherence to CMS/state guidelines, with full-time hours and benefits