Medical Coding Auditor - Compliance & Revenue Integrity

CVS Health Corporation; Salt Lake City (UT); On-site; USD 44,000 - 102,000; Full time

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error to ensure compliant coding practices. You will audit medical records, apply CMS and state guidelines, and discuss cases with Medical Directors to validate decisions.

The role requires CPC certification and 2+ years of coding experience, with strong knowledge of CPT/HCPCS/ICD-10. Full-time hours in Utah with competitive benefits and a pay range reflecting location and experience.

Qualifications

• AAPC CPC certification is required.
• 2+ years of medical coding, claims review, or 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 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 or modifiers billed align with documentation.
• Research and apply state, CMS and organizational guidelines related to audits with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud.
• Prepare clear, concise summaries of findings.
• Present case outcomes and rationale to internal partners clearly.
• Track recurring coding and billing issues to inform process improvements.
• Maintain appropriate records and documentation.
• Follow workflows to meet production metrics.

Skills

Attention to detail

Verbal communication

Written communication

Microsoft Excel

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Job description

CVS Health Corporation is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error to ensure compliant coding practices. You will audit medical records, apply CMS and state guidelines, and discuss cases with Medical Directors to validate decisions.

The role requires CPC certification and 2+ years of coding experience, with strong knowledge of CPT/HCPCS/ICD-10. Full-time hours in Utah with competitive benefits and a pay range reflecting location and experience.