Medical Coding Auditor (CPC) – Compliance & Fraud Detection

Hispanic Alliance for Career Enhancement; Nevada (IA); Hybrid; USD 43,888 - 93,574; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to review medical records for the Special Investigations Unit (SIU) to ensure coding accuracy and compliance. The role requires identifying billing patterns and ensuring state and federal guidelines are met.

The position emphasizes detailed audit work, clear written findings, and communication with investigators and leadership, with full-time hours and competitive benefits.

Qualifications

• CPC certification and 3+ years in medical coding or documentation auditing.
• Familiarity with CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements.
• Experience researching coding policies and applying guidelines.
• Proficiency with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS or modifiers match documentation.
• Provide written summaries of review findings.
• Articulate findings to investigators, Medicaid plan leadership, regulators, etc.
• Research CMS/state guidelines with minimal support.
• Identify potential billing errors, abuse, and fraud.
• Maintain records and follow workflows to meet metrics.
• Keep up-to-date coding knowledge with changes.

Skills

CPC certification

Medical coding

Documentation auditing

Excel

Word

Education

GED or equivalent

AAPC CPC Certification

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to review medical records for the Special Investigations Unit (SIU) to ensure coding accuracy and compliance. The role requires identifying billing patterns and ensuring state and federal guidelines are met.

The position emphasizes detailed audit work, clear written findings, and communication with investigators and leadership, with full-time hours and competitive benefits.