Medical Coding Auditor & Compliance Analyst

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst in Honolulu to perform medical claim reviews for waste and error and ensure coding accuracy and documentation compliance. You will audit CPT/HCPCS, modifiers, and CMS guidelines across patient records.

Responsibilities include researching policies, discussing cases with Medical Directors, and documenting findings. Strong Excel/Word skills and CPC certification are required; 40 hours per week full-time with competitive benefits.

Qualifications

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

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS and modifiers align with documentation.
• Research and apply state, CMS and organizational guidelines to audits.
• Review cases with Medical Directors to validate decisions.
• Assist with coding policy investigations and fraud/waste/abuse inquiries.
• Identify potential billing errors and compliance issues.
• Prepare clear summaries of findings and rationales.
• Present case outcomes to internal partners clearly.
• Track recurring coding issues to improve processes.
• Maintain organized records and documentation.

Skills

Attention to detail

Written and verbal communication

Education

AAPC CPC Certification

High School Diploma or GED

Tools

Excel

Word

Job description

CVS Health Corporation is seeking a Certified Coding Analyst in Honolulu to perform medical claim reviews for waste and error and ensure coding accuracy and documentation compliance. You will audit CPT/HCPCS, modifiers, and CMS guidelines across patient records.

Responsibilities include researching policies, discussing cases with Medical Directors, and documenting findings. Strong Excel/Word skills and CPC certification are required; 40 hours per week full-time with competitive benefits.