Senior Medical Coding Audit Specialist

CVS Pharmacy; Pierre (SD); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Pharmacy is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring correct CPT/HCPCS/ICD-10 coding and proper documentation.

Responsibilities include comprehensive medical record audits, applying CMS/state guidelines, discussing cases with Medical Directors, identifying billing errors, and summarizing findings for internal partners. Requires CPC and 2+ years in medical coding; full-time, on-site in the United States.

Qualifications

• Knowledge of CPT/HCPCS/ICD-10 coding and modifiers.
• Experience in medical coding, claims review or auditing.
• Strong attention to detail and data interpretation.
• Excellent written and verbal communication skills.

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS/ICD-10 alignment with documentation.
• Research and apply CMS and state guidelines with minimal support.
• Review cases with Medical Directors to validate decisions as needed.
• Identify billing errors, abuse and fraud and document findings clearly.
• Present case outcomes and rationale to internal partners.
• Track recurring coding issues to inform process improvements.

Skills

CPT/HCPCS/ ICD-10 knowledge

Auditing and claims review

Attention to detail

Written and verbal communication

Education

AAPC CPC Certification

High School diploma or GED

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Pharmacy is seeking a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring correct CPT/HCPCS/ICD-10 coding and proper documentation.

Responsibilities include comprehensive medical record audits, applying CMS/state guidelines, discussing cases with Medical Directors, identifying billing errors, and summarizing findings for internal partners. Requires CPC and 2+ years in medical coding; full-time, on-site in the United States.