Medical Coding & Claims Audit Specialist

Hispanic Alliance for Career Enhancement; Washington; Hybrid; USD 43,888 - 93,574; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus opportunities

Paid time off

Retirement savings options

Job summary

CVS Health in the United States is seeking a Certified Professional Coder (CPC) to perform medical record reviews for the SIU and ensure coding compliance across medical, behavioral, and other healthcare services.

You will audit CPT/HCPCS, document findings, and communicate outcomes to investigators, plan leadership, and regulators while staying current with coding guidelines. This full-time role offers a comprehensive benefits package and the potential for bonus opportunities.

Qualifications

• AAPC CPC Certification (CPC).
• 3+ years of medical coding or documentation auditing experience.
• Knowledge of CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements.
• Experience researching coding guidelines and policies.
• Microsoft Excel and Word proficiency.

Responsibilities

• Conduct comprehensive audits to ensure CPT/HCPCS and modifiers match documentation.
• Provide detailed written summaries of audit findings.
• Articulate findings to investigators, plan leadership, and regulators.
• Apply state and CMS guidelines to audits with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify billing errors, abuse, and fraud; support prepayment review.
• Maintain records and follow workflows to meet metrics.
• Stay up-to-date with coding changes and reimbursement rules.

Skills

CPC Certification

3+ years experience

CPT/HCPCS/ICD-10 knowledge

CMS 1500 & UB04 familiarity

Research coding & policies

Excel & Word proficiency

Education

GED or equivalent

AAPC CPC Certification

Tools

Excel

Word

Job description

CVS Health in the United States is seeking a Certified Professional Coder (CPC) to perform medical record reviews for the SIU and ensure coding compliance across medical, behavioral, and other healthcare services.

You will audit CPT/HCPCS, document findings, and communicate outcomes to investigators, plan leadership, and regulators while staying current with coding guidelines. This full-time role offers a comprehensive benefits package and the potential for bonus opportunities.