CVS Health
Senior Coding Quality Analyst (CPC) – Special Investigations Unit (Aetna SIU)
$47K–$102K
MN - Work from home · Remote/Hybrid · Senior · Full-time · Posted Oct 12, 2026
- Experience
- 1+ year in each of the three specified experience areas: quality review of coding consultant decisions, development and implementation of quality remediation plans, and medical coding in a Fraud, Waste, Abuse and/or error department.
- Education
- AAPC Certified Professional Coder Certification (CPC); GED or High School diploma.
About the job
Reviews healthcare claims and medical records for coding quality, compliance, and potential billing errors or fraud for the Special Investigations Unit.
What you'll do
- Review medical coding decisions and records against documentation, coding guidelines, and payer, state, and federal requirements.
- Analyze evidence and billing patterns to identify errors, abuse, or potential fraud; prepare written findings and handle complex reviews.
- Mentor coders, support team operations, and identify process improvements and cases for potential prepayment review.
What they ask for
- AAPC CPC certification.
- At least 1 year reviewing coding consultant decisions for quality purposes.
- At least 1 year developing and implementing quality remediation plans.
- At least 1 year of medical coding experience in a Fraud, Waste, Abuse and/or error department; knowledge of CPT, HCPCS, ICD-10, coding research, and Microsoft Excel and Word.
Nice to have
- CPMA certification.
- Excellent communication and analytical skills, with strong attention to detail and ability to review and interpret data.
Pay
$46,988.00 - $102,000.00 (base salary)
Tools
CPT, HCPCS, ICD-10, Microsoft products, Excel, Word
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