Certified Medical Coder - Audit & Compliance Specialist

Hispanic Alliance for Career Enhancement; Virginia (MN); Hybrid; USD 43,888 - 93,574; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Eligibility for benefits

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy, proper documentation, and compliance with state and federal guidelines.

Expect detailed audits, written findings, and collaboration with investigators and regulators. Requirements include CPC certification, 3+ years of coding/auditing experience, and proficiency with CPT/HCPCS/ICD-10.

Qualifications

• AAPC CPC certification required.
• 3+ years of medical coding or documentation auditing experience.
• Knowledge of CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements.
• Experience with researching coding and policies.
• Experience with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS usage.
• Provide written summaries of findings.
• Articulate findings to investigators, regulators, and providers.
• Research and apply state or CMS guidelines related to audits.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Maintain appropriate records and follow workflows to meet metrics.
• Keep up-to-date coding knowledge with changes in guidelines.

Skills

Attention to detail

Communication skills

Analytical skills

Behavioral Health coding

Auditing experience

Education

GED or equivalent

AAPC CPC Certification

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy, proper documentation, and compliance with state and federal guidelines.

Expect detailed audits, written findings, and collaboration with investigators and regulators. Requirements include CPC certification, 3+ years of coding/auditing experience, and proficiency with CPT/HCPCS/ICD-10.