Medical Coding Auditor & Compliance Analyst

AAPC; Oklahoma City (OK); On-site; USD 44,000 - 102,000; Full time

Job summary

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy per CPT/HCPCS/ICD-10 and modifiers. The Analyst will audit medical records, discuss cases with Medical Directors, and help educate providers while maintaining compliance with state, federal, and company policies.

The role requires 2+ years in medical coding and CPC certification, strong attention to detail, and proficiency with MS Office.

Qualifications

• CPC certification required.
• 2+ years of medical coding, claims review, auditing.
• Knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements.
• Proficiency with Microsoft Excel and Word.
• Strong attention to detail and communication skills.
• Experience with researching coding and policies.

Responsibilities

• Perform comprehensive medical record audits for CPT/HCPCS/modifier accuracy.
• Research guidelines and apply CMS and organizational policies.
• Discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Prepare clear summaries of findings.
• Present outcomes and rationale to internal partners.
• Track recurring coding issues to improve processes.
• Maintain documentation and records.

Skills

CPC certification

Attention to detail

Communication skills

Data interpretation

Education

AAPC CPC Certification

High School diploma or GED

Tools

MS Excel

MS Word

Encoder Pro

Job description

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy per CPT/HCPCS/ICD-10 and modifiers. The Analyst will audit medical records, discuss cases with Medical Directors, and help educate providers while maintaining compliance with state, federal, and company policies.

The role requires 2+ years in medical coding and CPC certification, strong attention to detail, and proficiency with MS Office.