Waste & Error Coding Manager: Lead Audit & Quality

CVS Health Corporation; Harrisburg (Dauphin County); Hybrid; USD 54,000 - 146,000; Full time

Benefits offered by this job

Hybrid work environment

Comprehensive benefits package

Job summary

CVS Health Corporation is seeking a Waste & Error Certified Coding Manager to lead a team of Certified Coding Analysts and oversee audits that identify billing errors, waste, abuse, and fraud. You will manage staffing, performance, and process improvements to deliver high quality results with strong collaboration across Legal, Compliance, and Medical Directors.

The role requires extensive coding expertise, people leadership, and alignment with state and federal policies.

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 (Initial review, reconsiderations & appeals), and related waste and error activities performed by the coders.
• 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.
• Establish and monitor quality review processes for coding audit work completed by the team.
• Review quality results, identify performance gaps, and implement targeted coaching, training, or corrective action plans.
• Ensure consistent application of coding guidelines, reimbursement requirements, business rules, workflows, and documentation standards.
• Maintain adherence to state, federal, contractual, accreditation, and organizational requirements.
• Partner with Legal, Compliance, Medical Directors, and other subject matter experts to resolve complex or high‑risk issues.
• Support internal audits, external audits, regulatory reviews, and documentation requests.
• Develop and monitor key performance indicators for productivity, quality, inventory, turnaround time, savings, and operational outcomes.
• Analyze team performance, coding trends, recurring billing issues, and root causes to identify improvement opportunities.
• Prepare and present operational updates, performance results, risks, decisions, and recommendations to leadership and business partners.
• Drive process standardization, workflow improvements, automation, system enhancements, and effective use of department resources.
• Participate in system implementations, upgrades, pilots, and new program launches affecting coding audit operations.
• Use audit findings and trend data to support provider education, policy clarification, analyst development, and prevention strategies.
• Collaborate with Senior Leadership, Medical Directors, Legal, Compliance, Analytics, Operations, Technology, and Payment Integrity partners.
• Serve as the management escalation point for complex cases, operational barriers, coding disputes, and stakeholder concerns.
• Communicate difficult or sensitive operational issues clearly, objectively, and with recommended solutions.
• Build alignment across partners while protecting coding accuracy, regulatory compliance, provider experience, and business objectives.
• Represent the Waste & Error coding team in governance meetings, business reviews, implementation activities, and strategic initiatives.

Skills

Medical coding

Coding audits

People leadership

CPT/HCPCS/ICD-10 knowledge

Policy interpretation

Excel

Effective communication

Education

Bachelor's degree in health information management or related field

High school diploma or GED

Tools

EncoderPro or similar coding tool

Job description

CVS Health Corporation is seeking a Waste & Error Certified Coding Manager to lead a team of Certified Coding Analysts and oversee audits that identify billing errors, waste, abuse, and fraud. You will manage staffing, performance, and process improvements to deliver high quality results with strong collaboration across Legal, Compliance, and Medical Directors.

The role requires extensive coding expertise, people leadership, and alignment with state and federal policies.