Senior Medical Coding Auditor (CPC)

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

Benefits offered by this job

Health insurance

Retirement savings options

Paid time off

Wellness programs

Job summary

CVS Health Corporation is seeking a Certified Coding Analyst to review medical claims and audit records for coding accuracy and compliance. The analyst will ensure CPT/HCPCS, ICD-10 and modifiers align with documentation and CMS/state requirements.

Collaborating with Medical Directors, the role involves researching coding questions, identifying billing errors, and documenting findings to support provider education and 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, including changes to compliance and reimbursement.
• Experience researching coding and policies.
• Experience with Microsoft Excel and Word.
• Strong attention to detail and ability to review and interpret data.
• Strong written and verbal communication skills.

Responsibilities

• Audit medical records to ensure CPT/HCPCS or modifiers billed are consistent with documentation.
• Research and apply state, CMS and organizational guidelines related to audits.
• Review cases with Medical Directors to validate decisions.
• Investigate coding questions and state/federal policies.
• Identify potential billing errors, abuse and fraud.
• Prepare clear, concise summaries of findings.
• Present outcomes and rationale to internal partners.
• Track recurring coding issues to inform process improvements.
• Maintain records and follow workflows to meet production metrics.

Skills

Attention to detail

Written and verbal communication

Analytical problem-solving

Encoder pro experience

Researching coding/policies

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 and audit records for coding accuracy and compliance. The analyst will ensure CPT/HCPCS, ICD-10 and modifiers align with documentation and CMS/state requirements.

Collaborating with Medical Directors, the role involves researching coding questions, identifying billing errors, and documenting findings to support provider education and process improvements.