Medical Coding Auditor - Claims Compliance & Audit Expert

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation seeks a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliant documentation across medical and institutional providers. The role requires up-to-date CPT/HCPCS/ICD-10 knowledge, CMS 1500/UB04 familiarity, and collaboration with Medical Directors.

The analyst will audit records, identify errors, and communicate findings clearly to internal teams, supporting process improvements and provider education.

Qualifications

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

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS or modifiers align with documentation.
• Research CMS/state guidelines and company policies related to audits.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research on coding questions and policies.
• Identify potential billing errors, abuse and fraud; document findings clearly.
• Present outcomes and rationale to internal partners; ensure traceability of decisions.
• Track recurring coding and billing issues to inform process improvements and provider education.
• Maintain orderly records and supporting documentation.

Skills

CPC certification

Medical coding

Claims review

Auditing

MS Excel

MS Word

Attention to detail

Communication skills

Education

CPC certification

High school diploma or GED

Tools

Excel

Word

Job description

CVS Health Corporation seeks a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliant documentation across medical and institutional providers. The role requires up-to-date CPT/HCPCS/ICD-10 knowledge, CMS 1500/UB04 familiarity, and collaboration with Medical Directors.

The analyst will audit records, identify errors, and communicate findings clearly to internal teams, supporting process improvements and provider education.