Program Integrity Auditor — Drive Compliance & Insights

CVS Health Corporation; Oregon; Hybrid; USD 47,000 - 122,000; Full time

Job summary

CVS Health is seeking a Program Integrity Auditor to review medical and provider records for correct coding and documentation, across Medicaid-related services. You will identify aberrant billing patterns, support investigations, and help ensure compliance with state and federal requirements.

Responsibilities include coordinating audits, educating providers on regulatory rules, and contributing to the plan's anti-FWA initiatives.

Qualifications

• Associate’s degree or equivalent experience (2+ years of relevant experience + high school diploma or GED).
• Active CPC, CCS, or CPMA license required.
• 3–5 years of experience reviewing claims data and medical records.

Responsibilities

• Audit records for multiple lines of business to ensure proper coding and documentation.
• Coordinate audit documentation and reports for internal/external staff and stakeholders.
• Identify aberrant billing patterns and potential FWA; assist with investigations and regulator reporting.

Skills

Analytical skills

Attention to detail

Communication skills

Team collaboration

Presentation skills

Adaptability

Education

Associate’s degree or equivalent experience

Tools

QuickBase

Job description

CVS Health is seeking a Program Integrity Auditor to review medical and provider records for correct coding and documentation, across Medicaid-related services. You will identify aberrant billing patterns, support investigations, and help ensure compliance with state and federal requirements.

Responsibilities include coordinating audits, educating providers on regulatory rules, and contributing to the plan's anti-FWA initiatives.