Waste & Error Coding Manager: Audit & Compliance Lead

CVS Health Corporation

Tallahassee (FL)

Hybrid

USD 54,000 - 146,000

Full time

5 days ago

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Job summary

CVS Health Corporation is seeking a Waste & Error Certified Coding Manager to lead the Certified Coding Analysts and W&E Team Lead roles. The position focuses on reviewing medical claims, performing coding audits, and driving accuracy, compliance, and high-quality delivery.

You will partner with leadership across Legal, Compliance, Medical Directors, Analytics, and Operations to improve performance, staffing, and process improvements while fostering a collaborative team environment.

Qualifications

Active AAPC Certified Coder CPC, CCS, RHIT or RN license w/significant coding/ auditing experience may be considered.
5+ years of experience in medical coding, claims review, auditing, payment integrity, fraud, waste, abuse, or error review.
2+ years of people leadership, supervisory, or team management experience, including performance management, coaching, and employee development.
Experience leading coding quality programs, productivity management, workload oversight, and targeted remediation activities.
Strong knowledge of CPT, HCPCS, ICD-10, CMS 1500, UB-04, coding compliance, and reimbursement requirements.
Experience researching and applying state, federal, CMS, and organizational policies.
Demonstrated ability to manage multiple priorities, resolve complex issues, and meet operational deadlines.
Strong written and verbal communication skills, including the ability to present performance results and case decisions to internal and external stakeholders.
Proficiency with Microsoft Excel and Word; ability to interpret operational and quality data.

Responsibilities

Lead, coach, and develop a team of Certified Coding Analysts and Senior Certified Coding Analysts.
Establish clear role expectations, performance goals, productivity standards, quality requirements, and accountability measures.
Conduct regular performance discussions, provide timely feedback, recognize strong performance, and address performance or conduct concerns.
Oversee hiring, onboarding, training, succession planning, engagement, and retention for the coding team.
Deliver technical coaching, peer support, quality remediation, and ongoing education.
Create an inclusive, collaborative team environment that promotes knowledge sharing, sound judgment, and continuous learning.
Provide operational oversight for medical record reviews coding audits and related waste and error activities.
Assign priorities and manage work queues to ensure production, turnaround time, quality, and service level expectations are met.
Monitor workload, staffing capacity, inventory, aging, and productivity trends; adjust assignments and resources as needed.
Ensure analysts conduct comprehensive reviews and accurately apply CPT, HCPCS, ICD-10, modifier, CMS, state, federal, and organizational requirements.
Oversee escalation pathways for complex coding questions, policy interpretation, Medical Director review, and case decisions.
Ensure case findings and decision rationales are clear, complete, consistently documented, and supportable.
Perform other duties as assigned.