Medical Coding Auditor & Compliance Analyst

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

Job summary

CVS Health Corporation is hiring a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding practices align with documentation and regulatory requirements. The role involves audits, policy research, and collaboration with Medical Directors to validate decisions.

The ideal candidate has CPC certification, 2+ years of medical coding/claims review experience, and strong Excel/Word skills.

Qualifications

• Experience with medical coding, claims review, auditing.
• Familiarity with CPT, HCPCS, ICD-10 and modifiers.
• Experience with CMS 1500 and UB04 data elements.

Responsibilities

• Conduct a comprehensive medical record audit to ensure billing codes match 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 and policies.
• Identify potential billing errors, abuse and fraud.
• Prepare clear, concise summaries of findings and rationale.

Skills

Attention to detail

Written and verbal communication

Medical claims review experience

Knowledge of CPT/HCPCS/ICD-10

Education

AAPC CPC Certification

High School Diploma or GED

Tools

Excel

Word

Job description

CVS Health Corporation is hiring a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding practices align with documentation and regulatory requirements. The role involves audits, policy research, and collaboration with Medical Directors to validate decisions.

The ideal candidate has CPC certification, 2+ years of medical coding/claims review experience, and strong Excel/Word skills.