Strategic Medical Coding Auditor & Compliance Analyst

CVS Health Corporation; Boston (MA); 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 is seeking 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. You will audit medical records, discuss cases with Medical Directors, and support provider education across a CVS Health network.

The ideal candidate holds AAPC CPC certification, has 2+ years in coding or auditing, and is proficient with CMS guidelines, UB04/HCFA data elements, and MS Excel/Word.

Qualifications

• AAPC CPC certification required.
• 2+ years of experience in 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 new changes.
• Experience with researching coding and policies.
• Proficient with Microsoft Excel and Word.
• Strong written and verbal communication skills.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS or modifiers match documentation.
• Research CMS and organizational guidelines related to audits.
• Review and discuss cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Prepare concise summaries of findings and present outcomes to internal partners.
• Track recurring coding issues to inform process improvements and provider education.

Skills

Attention to detail

Communication skills

Medical coding

Auditing experience

Education

AAPC CPC Certification

High School diploma or GED

Tools

Excel

Word

Job description

CVS Health Corporation is seeking 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. You will audit medical records, discuss cases with Medical Directors, and support provider education across a CVS Health network.

The ideal candidate holds AAPC CPC certification, has 2+ years in coding or auditing, and is proficient with CMS guidelines, UB04/HCFA data elements, and MS Excel/Word.