Medical Coding Auditor & Compliance Analyst

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

Benefits offered by this job

Comprehensive benefits package

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding compliance. The role requires CPT/HCPCS/ICD-10 knowledge, state and federal guideline research, and clear communication of findings to internal partners.

With at least 2+ years in medical coding and familiarity with CMS 1500/UB04, you will audit records, identify issues, and contribute to process improvements.

Qualifications

• AAPC CPC certification and 2+ years in medical coding and claims auditing.
• Strong knowledge CPT/HCPCS/ICD-10 and modifiers.
• Experience with CMS 1500 and UB04 data elements.
• Proficient in Excel and Word; detail-oriented.

Responsibilities

• Audit medical records to verify CPT/HCPCS or modifiers align with documentation.
• Research state, CMS and organizational guidelines for audits.
• Discuss cases with Medical Directors to validate decisions.
• Assist with coding questions, state and federal policy research.
• Identify potential billing errors, abuse, and fraud.
• Prepare clear summaries of findings and rationale.
• Present outcomes and reasoning to internal partners.
• Track recurring coding issues to inform improvements.
• Maintain records and follow workflows to meet production metrics.

Skills

CPC certification

Medical coding

Auditing experience

MS Excel

MS Word

Attention to detail

Communication skills

Education

AAPC CPC certification

High school diploma or GED

Tools

EncoderPro

Job description

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding compliance. The role requires CPT/HCPCS/ICD-10 knowledge, state and federal guideline research, and clear communication of findings to internal partners.

With at least 2+ years in medical coding and familiarity with CMS 1500/UB04, you will audit records, identify issues, and contribute to process improvements.