Senior Medical Coding Auditor & Compliance Analyst

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation seeks a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance with CPT/HCPCS, ICD-10, and modifiers across medical and institutional records.

The role requires 2+ years in medical coding, auditing, and claims review; CPC certification; proficient use of Excel/Word; and strong written and verbal communication to present findings and support process improvements.

Qualifications

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

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS or modifiers match documentation.
• Research and apply state, CMS and organizational guidelines for audits.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding policies.
• Identify potential billing errors, abuse and fraud.
• Prepare clear, concise findings summaries.
• Present case outcomes and rationale to internal partners.
• Track recurring coding issues to inform improvements.
• Maintain records and documentation.
• Follow workflows to meet production metrics.

Skills

Attention to detail

Written and verbal communication

Analytical thinking

Education

AAPC CPC certification

High School diploma or GED

Tools

Excel

Word

EncoderPro

Job description

CVS Health Corporation seeks a Certified Coding Analyst to perform medical claim reviews for waste and error, ensuring coding accuracy and compliance with CPT/HCPCS, ICD-10, and modifiers across medical and institutional records.

The role requires 2+ years in medical coding, auditing, and claims review; CPC certification; proficient use of Excel/Word; and strong written and verbal communication to present findings and support process improvements.