Senior Coding Quality Analyst – SIU Investigator

4004 Aetna Medicaid Administrators; Minnesota; Hybrid; USD 47,000 - 102,000; Full time

Job summary

CVS Health is seeking a Senior Coding Quality Analyst (CPC) for the Special Investigations Unit to review medical claims and ensure coding accuracy in accordance with CPT/HCPCS/ICD-10 and payer guidelines. You will analyze complex records, prepare detailed summaries, mentor coders, and contribute to process improvements.

This is a full-time role based in Minnesota with competitive benefits. The ideal candidate holds CPC, has 1+ year reviewing decisions, and is experienced in Fraud, Waste and

Qualifications

• AAPC CPC certification required.
• At least 1 year reviewing coding consultant decisions for quality.
• At least 1 year developing and implementing quality remediation plans.
• 1+ year experience in medical coding in Fraud, Waste, Abuse and/or error.
• Knowledge of CPT, HCPCS, ICD-10 guidelines and policies.
• Experience researching coding and payer policies; proficient with Excel/Word.

Responsibilities

• Conduct comprehensive quality reviews of completed medical coding reviews to ensure logic aligns with documentation and guidelines.
• Perform in depth medical record reviews across medical, behavioral health, transportation and other provider claims.
• Analyze data and evidence to identify potential billing errors, abuse or fraudulent activity.
• Prepare detailed written summaries of findings and articulate conclusions to leadership.
• Independently research state, CMS and payer guidelines relevant to audits and reviews.
• Identify opportunities for process improvements and cost savings.

Skills

CPC knowledge

Quality assurance

Medical coding

CPT/HCPCS/ICD-10

Policy research

Excel & Word

Data analysis

Education

AAPC CPC Certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Senior Coding Quality Analyst (CPC) for the Special Investigations Unit to review medical claims and ensure coding accuracy in accordance with CPT/HCPCS/ICD-10 and payer guidelines. You will analyze complex records, prepare detailed summaries, mentor coders, and contribute to process improvements.

This is a full-time role based in Minnesota with competitive benefits. The ideal candidate holds CPC, has 1+ year reviewing decisions, and is experienced in Fraud, Waste and