Medical Coding Auditor & Compliance Analyst

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

Benefits offered by this job

Medical, dental, vision benefits

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring compliance with coding practices. You will audit medical records, determine correct coding, and verify documentation while meeting state and federal requirements.

Responsibilities include presenting findings, researching policies, and collaborating with Medical Directors. AAPC CPC certification and strong attention to detail are essential; a comprehensive benefits package

Qualifications

• AAPC CPC certification required and up-to-date coding knowledge including CPT/HCPCS/ICD-10.
• Minimum 2+ years in medical coding, claims review, or auditing.
• Proficient in CMS 1500/UB04 data elements and coding guidelines.
• Strong research skills on coding policies and payer requirements.
• Experienced with Microsoft Excel and Word; detail-oriented data review.

Responsibilities

• Conduct comprehensive medical record audits to verify coding accuracy against documentation.
• Apply state, CMS, and organizational guidelines during audits with minimal supervision.
• Discuss cases with Medical Directors to validate decisions as needed.
• Identify potential billing errors, fraud indicators, and education needs.
• Prepare concise findings and present rationale to internal partners.
• Track recurring coding issues to inform process improvements.

Skills

Attention to detail

Verbal and written communication

Medical coding knowledge

CMS/ICD-10 knowledge

Education

AAPC CPC Certification

High School diploma or GED

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring compliance with coding practices. You will audit medical records, determine correct coding, and verify documentation while meeting state and federal requirements.

Responsibilities include presenting findings, researching policies, and collaborating with Medical Directors. AAPC CPC certification and strong attention to detail are essential; a comprehensive benefits package