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Senior Coding Quality Analyst (CPC) – Special Investigations Unit (Aetna SIU) at CVS Health - ApplyBlast

Senior Coding Quality Analyst (CPC) – Special Investigations Unit (Aetna SIU)

CVS Health

28 days ago

3.2 on Glassdoor

Remote

Full Time

Senior

0 applicants

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About this role

The Senior Coding Quality Analyst (CPC) – Special Investigations Unit performs comprehensive medical claim reviews to ensure compliance with coding practices and identify potential billing errors, abuse, or fraudulent activity. The role involves analyzing data and documentation to recognize concerning billing patterns, preparing detailed summaries of findings, and providing mentorship to coders. This position requires maintaining up-to-date knowledge of coding standards and contributing to continuous improvement of investigative methodologies.

Responsibilities

Conduct comprehensive quality reviews of medical coding to ensure compliance with guidelines
Analyze medical records and billing data to identify potential fraud, waste, or abuse
Mentor coders and provide training on coding quality and documentation standards

Skills

Qualifications

AAPC CPC certificationCPMA certification

About CVS Health

cvshealth.com

Headquarters

Woonsocket, Rhode Island, United States

Company Size

10001+ employees

Founded

1963

View Profile

CVS Health is America's leading health solutions company, providing integrated services across retail pharmacy (CVS Pharmacy), pharmacy benefits management (CVS Caremark), and health insurance (Aetna). The company offers pharmacy services, health plans, clinical care (including MinuteClinic), and health-and-wellness programs for consumers, employers, and government payers. By combining a large national retail footprint with claims processing, care management, and clinical services, CVS Health aims to coordinate care, lower costs, and improve health outcomes. Businesses and consumers use its solutions for medication management, plan administration, and in-person and virtual care.