Senior Coding Quality Analyst – Special Investigations Unit

CVS Health

. Conduct comprehensive quality reviews of completed medical coding reviews for alignment with medical record documentation, CPT/HCPCS/ICD-10 guidelines, and payer, state, and federal requirements .

Posted 10/12/2026full-timeMinnesota • United StatesSenior💰 $46,988 - $102,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical coding quality reviews, compliance with CPT, HCPCS, and ICD-10 guidelines, and the ability to analyze data for billing accuracy. Proficient in mentoring coders and implementing quality remediation plans while maintaining documentation and meeting performance metrics.

Highest-signal resume keywords

AAPC CPC CertificationMedical Coding ExperienceQuality Remediation PlansData Analysis SkillsCPT/HCPCS/ICD-10 Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical CodingQuality ReviewData AnalysisDocumentation StandardsBilling Error IdentificationCompliance AuditsProcess ImprovementInvestigative MethodologiesQuality RemediationCoding Guidelines

Soft Skills

Excellent Communication SkillsStrong Attention to DetailAnalytical SkillsMentorshipTeam Support

Tools & Technologies

Microsoft ExcelMicrosoft WordDepartmental ToolsTracking Logs

Certifications & Qualifications

AAPC CPC CertificationCPMA Certification

Industry Keywords

FraudWasteAbuseHealthcare Provider ClaimsPayer GuidelinesCMS GuidelinesPerformance MetricsQuality Standards

About the role

Key responsibilities & impact

Conduct comprehensive quality reviews of completed medical coding reviews for alignment with medical record documentation, CPT/HCPCS/ICD-10 guidelines, and payer, state, and federal requirements
Perform in-depth medical record reviews across medical, behavioral health, transportation, and other healthcare provider claims
Analyze data, documentation, and evidence to identify potential billing errors, abuse, fraudulent activity, and concerning billing patterns or trends
Handle complex coding reviews involving legal, compliance, escalations, audits, and rework initiatives
Prepare detailed written summaries of findings and articulate conclusions to leadership
Research and apply state, CMS, and payer-specific guidelines for audits and reviews
Identify process improvements, cost savings, and cases warranting prepayment review
Maintain accurate documentation, records, files, and tracking logs while meeting deadlines and performance metrics
Use departmental tools and workflows to support daily operations
Provide mentorship and training to coders on coding quality, documentation standards, and review methodology
Serve as management backup and support team operations during the manager’s absence
Maintain current knowledge of coding standards, compliance changes, reimbursement methodologies, and investigatory best practices
Contribute to continuous improvement of investigative methodologies, tools, and processes

Requirements

What you’ll need

AAPC CPC certification
1+ year of reviewing coding consultant decisions for quality purposes
1+ year of developing and implementing quality remediation plans
1+ year of experience in medical coding in a Fraud, Waste, Abuse and/or error department
Knowledge of standard industry coding guides and guidelines including CPT, HCPCS, and ICD-10
Experience researching coding and policies
Experience with Microsoft products, including Excel and Word
GED or High School diploma
CPMA certification preferred
Excellent communication skills preferred
Excellent analytical skills preferred
Strong attention to detail and ability to review and interpret data preferred

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program eligibility