Certified Coding Auditor (CPC), Analyst

Were building a world of health around every individual shaping a more connected convenient and compassionate health experience. At CVS Health youll be surrounded by passionate colleagues who care deeply innovate with purpose hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger helping to simplify health care one person one family and one community at a time.

The Certified Coding Analyst will perform medical claim reviews for waste and error to ensure compliance with coding practices through a comprehensive record review for medical and institutional providers. The Analyst must have the ability to determine correct coding and appropriate documentation during the review of medical records. The Analyst must also ensure state; federal and company requirements are met.

• Conduct a comprehensive medical record audit to ensure the CPT/HCPCS or modifiers billed are consistent with medical record documentation.
• Research and accurately apply state CMS and organizational guidelines related to the audit with minimal support.
• Review and discuss cases with Medical Directors to validate decisions as needed.
• Assist with investigative research related to coding questions state and federal policies.
• Identify potential billing errors abuse and fraud.
• Prepare clear concise summary of findings
• Ability to present case outcomes and decision rationale in a clear concise manner to internal partners.
• Track and trend recurring coding and billing issues to inform process improvements and provider education.
• Maintain appropriate records files documentation etc.
• Uses department resources regularly
• Follows workflows with minimal assistance to perform daily work to meet production metrics

Required Qualifications

AAPC Certified professional Coder (CPC) certification
2 years of experience in medical coding claims review auditing
Strong knowledge of standard industry coding guides and guidelines including CPT HCPCS ICD-10 and modifiers
CMS 1500 and UB04 data elements
Maintains up-to-date coding knowledge including new changes to coding compliance and reimbursement.
Experience with researching coding and policies.
Experience with Microsoft products; Excel and Word
Strong attention to detail and ability to review and interpret data.
Demonstrates strong written and verbal communication skills

Preferred Qualifications

• 1 years of experience in appeal/recon medical coding claims reviews auditing
• Medicaid auditing experience
• Prior auditing experience in fraud waste abuse and error or payment integrity
• Excellent communication skills
• Strong analytical and problem-solving skills
• Encoder pro experience

Education

• AAPC Certified Professional Coder Certification (CPC)
• High School diploma or GED

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience education geography and other relevant factors. This position is eligible for a CVS Health bonus commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers patients members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.