We’re building a world of health around every individual, shaping a more connected, convenient, and compassionate health experience. As part of CVS Health, you’ll help simplify health care one person, one family, and one community at a time.
The Certified Coding Analyst performs medical claim reviews to identify waste and error and ensure compliance with coding practices through comprehensive record review for medical and institutional providers. This role determines correct coding and appropriate documentation during medical record review and ensures state, federal, and company requirements are met.
The analyst conducts comprehensive medical record audits, researches and applies state, CMS, and organizational guidelines, reviews cases with Medical Directors as needed, identifies billing errors and potential fraud, prepares clear summaries of findings, presents case outcomes and rationale to internal partners, tracks recurring coding and billing issues, and maintains accurate records while meeting production metrics.
Required qualifications
- AAPC Certified Professional Coder (CPC) certification
- 2+ years of experience in medical coding, claims review, or auditing
- Strong knowledge of CPT, HCPCS, ICD-10, modifiers, CMS 1500, and UB04 data elements
- Current knowledge of coding compliance and reimbursement updates
- Experience researching coding and policy guidelines
- Proficiency with Microsoft Excel and Word
- Strong attention to detail and ability to review and interpret data
- Strong written and verbal communication skills
Preferred qualifications
- 1+ years of experience in appeal/recon medical coding, claims reviews, or auditing
- Medicaid auditing experience
- Prior auditing experience in fraud, waste, abuse, error, or payment integrity
- Excellent communication, analytical, and problem-solving skills
- EncoderPro experience
Education
- High school diploma or GED
- AAPC CPC certification
Benefits
- Comprehensive medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Eligibility for CVS Health bonus, commission, or short-term incentive program
- Additional benefits provided during the application process
Location
Alabama, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$43,888 - $102,081
Remote work allowed
No
Posted
1 month ago