Medical Coding Auditor – Compliance & Claims Review

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Retirement savings

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and regulatory compliance. You will audit CPT/HCPCS, modifiers, and documentation across medical and institutional providers.

Responsibilities include researching guidelines, discussing cases with Medical Directors, and identifying billing errors while preparing clear summaries for stakeholders.

Qualifications

• Strong attention to detail and ability to review and interpret data.
• Certification: AAPC CPC required.
• Experienced with CPT, HCPCS, ICD-10 and modifiers.
• Familiarity with CMS 1500 and UB04 data elements.
• Maintains up-to-date coding knowledge and policies.

Responsibilities

• Conduct comprehensive medical record audits to verify coding accuracy.
• Research state, CMS and organizational guidelines related to audits.
• Discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud.
• Prepare concise findings and present outcomes to internal partners.

Skills

Attention to detail

Written communication

Verbal communication

Analytical thinking

Problem solving

Education

AAPC CPC certification

High School diploma or GED

Tools

Microsoft Excel

Microsoft Word

Encoder Pro

Job description

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and regulatory compliance. You will audit CPT/HCPCS, modifiers, and documentation across medical and institutional providers.

Responsibilities include researching guidelines, discussing cases with Medical Directors, and identifying billing errors while preparing clear summaries for stakeholders.