Medical Coding Auditor & Compliance Analyst

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

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Retirement savings options

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance with CPT/HCPCS, ICD-10, and modifiers.

You will audit medical records, apply CMS and organizational guidelines, discuss cases with Medical Directors, identify billing issues, and help educate providers while tracking trends to drive improvements.

Qualifications

• Must hold AAPC CPC certification and 2+ years in medical coding, claims review, or auditing.
• Strong knowledge of CPT, HCPCS, ICD-10, and modifiers.
• Experience with CMS 1500 and UB04 data elements; staying current with coding guidelines.

Responsibilities

• Conduct comprehensive medical record audits to ensure proper CPT/HCPCS and modifiers.
• Research and apply CMS, state, and organizational guidelines with minimal supervision.
• Review and discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud, and document findings clearly.
• Prepare concise summaries and present outcomes to internal partners.
• Track recurring coding issues to inform process improvements and education.
• Maintain organized records and follow workflows to meet production metrics.

Skills

Attention to detail

Written & verbal communication

Analytical thinking

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 coding accuracy and compliance with CPT/HCPCS, ICD-10, and modifiers.

You will audit medical records, apply CMS and organizational guidelines, discuss cases with Medical Directors, identify billing issues, and help educate providers while tracking trends to drive improvements.