About this opportunity
CVS Health lists this Certified Coding Auditor (CPC), Analyst opportunity in lansing, Michigan. Review the employer’s description below for duties, qualifications and application requirements.
Job description
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable 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.
nThe 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.
nnnConduct a comprehensive medical record audit to ensure the CPT/HCPCS or modifiers billed are consistent with medical record documentation.
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nnResearch and accurately apply state, CMS and organizational guidelines related to the audit with minimal support.
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nnReview and discuss cases with Medical Directors to validate decisions as needed.
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nnAssist with investigative research related to coding questions, state and federal policies.
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nnIdentify potential billing errors, abuse, and fraud.
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nnPrepare clear, concise summary of findings
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nnAbility to present case outcomes and decision rationale in a clear, concise manner to internal partners.
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nnTrack and trend recurring coding and billing issues to inform process improvements and provider education.
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nnMaintain appropriate records, files, documentation, etc.
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nnUses department resources regularly
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nnFollows workflows with minimal assistance to perform daily work to meet production metrics
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n nRequired Qualifications
n• AAPC Certified professional Coder (CPC) certification
n• 2+ years of experience in medical coding, claims review, auditing
n• Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10, and modifiers
n• CMS 1500 and UB04 data elements
n• Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement.
n• Experience with researching coding and policies.
n• Experience with Microsoft products; Excel and Word
n• Strong attention to detail and ability to review and interpret data.
n• Demonstrates strong written and verbal communication skills
nPreferred Qualifications
nnn1+ years of experience in appeal/recon medical coding, claims reviews, auditing
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nnMedicaid auditing experience
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nnPrior auditing experience in fraud, waste, abuse and error, or payment integrity
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nnExcellent communication skills
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nnStrong analytical and problem-solving skills
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nnEncoder pro experience
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n nEducation
nnnAAPC Certified Professional Coder Certification (CPC)
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nnHigh School diploma or GED
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n nAnticipated Weekly Hours
n40
nTime Type
nFull time
nPay Range
nThe typical pay range for this role is:
n$43,888.00 - $102,081.00
nThis 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.
nOur 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.
nGreat benefits for great people
nWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
nThis full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
nAdditional details about available benefits are provided during the application process and on Benefits Moments ( .
nWe anticipate the application window for this opening will close on: 10/17/2026
nQualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
nCVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.
Worksite address
lansing, MI, 48900, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.