Senior Medical Coding Audit Specialist

CVS Health Corporation; Juneau (AK); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Bonus eligibility

Job summary

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews with focus on waste and error, ensuring adherence to CPT/HCPCS/ICD-10 coding standards and regulatory requirements. You will review documentation and discuss cases with Medical Directors as needed.

This full-time role in Juneau, Alaska requires 2+ years of coding experience and strong attention to detail, with a comprehensive benefits package and potential for bonuses.

Qualifications

• AAPC CPC Certification required.
• 2+ years of medical coding, claims review, auditing experience.
• Strong knowledge of CPT, HCPCS, ICD-10 and modifiers.
• CMS 1500 and UB04 data elements familiarity.
• Maintains up-to-date coding knowledge.
• Experience researching coding and policies.
• Proficient in Microsoft Excel and Word.
• Excellent attention to detail and data interpretation.
• Strong written and verbal communication skills.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS or modifiers match documentation.
• Research and apply CMS and organizational guidelines for audits with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Prepare clear, concise summaries of findings.

Skills

CPC certification

Medical coding experience

CPT/HCPCS/ICD-10 knowledge

CMS 1500/UB04 elements

Excel

Word

Attention to detail

Written and verbal communication

Education

AAPC CPC Certification

High School diploma or GED

Tools

EncoderPro

Job description

CVS Health is seeking a Certified Coding Analyst to perform medical claim reviews with focus on waste and error, ensuring adherence to CPT/HCPCS/ICD-10 coding standards and regulatory requirements. You will review documentation and discuss cases with Medical Directors as needed.

This full-time role in Juneau, Alaska requires 2+ years of coding experience and strong attention to detail, with a comprehensive benefits package and potential for bonuses.