Senior Medical Coding Auditor & Claims Quality Analyst

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

Benefits offered by this job

Medical Insurance

Dental Coverage

Vision Coverage

Paid Time Off

Retirement Savings

Wellness Programs

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst to review medical claims for waste and error, ensuring coding accuracy through thorough record reviews of providers and facilities.

The role requires CPC certification and 2+ years in medical coding or auditing, with strong knowledge of CPT, HCPCS, ICD-10, and CMS/state guidelines. This full‑time position offers broad benefits and growth opportunities.

Qualifications

• Certified Professional Coder in good standing with up‑to‑date coding knowledge.
• Experience applying CPT/HCPCS/ICD-10 guidelines during reviews.
• Ability to interpret policies and document audit findings clearly.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS modifiers against documentation.
• Research and apply CMS and state guidelines related to audits with minimal support.
• Review cases with Medical Directors to validate decisions as needed.
• Identify potential billing errors, abuse, and fraud.
• Prepare clear, concise summaries of findings and rationale.

Skills

CPC Certification

Medical Coding

Auditing

CMS Guidelines

Attention to detail

Education

AAPC CPC Certification

High School Diploma or GED

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health Corporation is seeking a Certified Coding Analyst to review medical claims for waste and error, ensuring coding accuracy through thorough record reviews of providers and facilities.

The role requires CPC certification and 2+ years in medical coding or auditing, with strong knowledge of CPT, HCPCS, ICD-10, and CMS/state guidelines. This full‑time position offers broad benefits and growth opportunities.