Senior Coding Quality Analyst, Special Investigations (CPC)

CVS Health Corporation; United States; Remote; USD 85,000 - 120,000; Full time

Job summary

CVS Health Corporation is seeking a Senior Coding Quality Analyst (CPC) for the Special Investigations Unit to review medical claims and ensure coding accuracy across medical, behavioral health, and related services.

The role requires applying state and payer guidelines, detecting billing irregularities, and documenting findings for leadership. You will mentor coders and support auditing initiatives while maintaining compliance and quality standards.

Qualifications

• AAPC CPC certification required.
• 1+ year of reviewing coding consultant decisions for quality purposes.

Responsibilities

• Perform comprehensive quality reviews of medical coding to ensure alignment with documentation and CPT/HCPCS/ICD-10 guidelines.
• Conduct in-depth medical record reviews across medical, behavioral health, transportation and other provider claims.
• Analyze data to identify potential billing errors, abuse or fraud and report findings.
• Prepare detailed written summaries of findings and present conclusions to leadership.
• Mentor coders on coding quality, documentation standards and review methodology.

Skills

Coding quality

Quality reviews

Data analysis

Mentorship

Education

AAPC CPC certification

Job description

CVS Health Corporation is seeking a Senior Coding Quality Analyst (CPC) for the Special Investigations Unit to review medical claims and ensure coding accuracy across medical, behavioral health, and related services.

The role requires applying state and payer guidelines, detecting billing irregularities, and documenting findings for leadership. You will mentor coders and support auditing initiatives while maintaining compliance and quality standards.