Medical Coding Auditor & Compliance Specialist

Internationalinsuranceprofessionals; Richmond (VA); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Certified Coding Analyst to review medical claims for waste and error, ensuring coding accuracy and compliance. You'll audit medical records, apply CPT/HCPCS/ICD-10 guidelines, and discuss findings with Medical Directors. Strong communication and detail orientation are essential for success.

Ideal candidates hold a CPC credential, 2+ years in coding/review, and are proficient with CMS/state guidelines. The role offers a comprehensive benefits package and full-time hours.

Qualifications

• AAPC CPC certification required.
• 2+ years of medical coding, claims review, auditing experience.

Responsibilities

• Perform comprehensive medical record audits to ensure CPT/HCPCS/modifier accuracy with documentation.
• Research CMS, state, and organizational guidelines related to audits.
• Discuss cases with Medical Directors to validate decisions as needed.
• Identify potential billing errors, waste, abuse and fraud.

Skills

Attention to detail

Analytical skills

Problem-solving

Written communication

Verbal communication

Microsoft Excel

Microsoft Word

Education

AAPC CPC certification

High School diploma or GED

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Coding Analyst to review medical claims for waste and error, ensuring coding accuracy and compliance. You'll audit medical records, apply CPT/HCPCS/ICD-10 guidelines, and discuss findings with Medical Directors. Strong communication and detail orientation are essential for success.

Ideal candidates hold a CPC credential, 2+ years in coding/review, and are proficient with CMS/state guidelines. The role offers a comprehensive benefits package and full-time hours.