CVS Health is seeking a Senior Coding Quality Analyst (CPC) to support the Special Investigations Unit by performing comprehensive medical claim reviews and quality assessments. This role focuses on ensuring coding compliance across medical, behavioral health, transportation, and other healthcare claims, while identifying billing errors, abuse, and potential fraudulent activity.
The position requires strong knowledge of coding guidelines and the ability to independently research and apply state, CMS, and payer-specific policies. The analyst will also prepare detailed findings, support process improvement efforts, and provide mentorship to coders.
- AAPC CPC certification
- 1+ year of experience reviewing coding consultant decisions for quality purposes
- 1+ year of experience developing and implementing quality remediation plans
- 1+ year of experience in medical coding within a Fraud, Waste, Abuse, or error department
- Knowledge of CPT, HCPCS, and ICD-10 coding guidelines
- Experience researching coding and policy requirements
- Proficiency with Microsoft Excel and Word
- Excellent communication and analytical skills
- Strong attention to detail and ability to interpret data
- GED or high school diploma
- Full-time position
- 40-hour work week
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Eligibility for bonus, commission, or short-term incentive program
- Comprehensive benefits package
Location
Saint Paul, Minnesota, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$46,988 - $102,000
Remote work allowed
No
Posted
3 weeks ago