Senior Medical Coding Quality Analyst — SIU & Compliance

CVS Health Corporation; Saint Paul (MN); On-site; USD 52,000 - 102,000; Full time

Job summary

CVS Health Corporation seeks a Senior Coding Quality Analyst (CPC) for the Special Investigations Unit to review medical, behavioral health, transportation, and other provider claims for coding accuracy and compliance. You will research guidelines, prepare findings, and mentor coders while supporting audits, escalations, and process improvements.

The role is full-time, with a 40-hour week and a comprehensive benefits package.

Qualifications

• Analytical and critical thinking skills for coding quality reviews.
• Experience with Fraud, Waste and Abuse review processes.
• Familiarity with CPT, HCPCS, ICD-10 guidelines and coding standards.
• Ability to research and apply coding policies and guidelines.

Responsibilities

• Conduct comprehensive quality reviews of completed coding reviews to ensure alignment with guidelines.
• Perform in-depth medical record reviews across medical, behavioral health, and other provider claims.
• Analyze data and documentation to identify billing errors, abuse, or fraud.
• Handle complex coding reviews including audits, escalations and rework initiatives.
• Prepare detailed written summaries of findings for leadership and stakeholders.
• Research state, CMS, and payer guidelines relevant to audits and reviews.
• Identify opportunities for process improvements and cost savings.
• Maintain documentation and tracking logs to meet deadlines and metrics.
• Provide mentorship and training to coders on quality and review methodologies.
• Serve as back-up to management and support team operations when needed.

Skills

Analytical skills

FWA experience

Coding guidelines

Policy research

Education

AAPC CPC certification (CPC)

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health Corporation seeks a Senior Coding Quality Analyst (CPC) for the Special Investigations Unit to review medical, behavioral health, transportation, and other provider claims for coding accuracy and compliance. You will research guidelines, prepare findings, and mentor coders while supporting audits, escalations, and process improvements.

The role is full-time, with a 40-hour week and a comprehensive benefits package.