Certified CPC Investigator: Medical Coding & Compliance

DaMar Staffing; Washington (District of Columbia); On-site; USD 44,000 - 102,000; Full time

Job summary

CVS Health in Washington, DC is seeking a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding accuracy across medical and behavioral health records. You will verify CPT, HCPCS, and CMS data, document findings, and communicate with investigators and regulators.

The role requires CPC certification, 3+ years of coding or auditing experience, strong Excel skills, and attention to detail; travel for meetings is possible, with base pay range and CVS benefits.

Qualifications

• AAPC CPC certification required.
• 3+ years of medical coding or documentation auditing.
• Strong knowledge of CPT, HCPCS, CMS 1500 and UB04.
• Experience researching coding policies and state regulations.
• Proficient in Microsoft Excel.

Responsibilities

• Conduct comprehensive medical record reviews to ensure billing aligns with medical records.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, Medicaid plan leadership, law enforcement, and regulators.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Identify opportunities for savings related to potential prepayment reviews.
• Maintain records and documentation.
• Travel for meetings and potential testimony.

Skills

CPC coding expertise

Attention to detail

Analytical thinking

Excellent communication

Excel proficiency

Education

GED or equivalent

AAPC CPC Certification

Tools

Microsoft Excel

Job description

CVS Health in Washington, DC is seeking a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding accuracy across medical and behavioral health records. You will verify CPT, HCPCS, and CMS data, document findings, and communicate with investigators and regulators.

The role requires CPC certification, 3+ years of coding or auditing experience, strong Excel skills, and attention to detail; travel for meetings is possible, with base pay range and CVS benefits.