Certified Medical Coder & Audit Specialist

Hispanic Alliance for Career Enhancement; Georgia; Hybrid; USD 43,888 - 93,574; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding accuracy and compliant documentation across medical, behavioral, transportation, and other healthcare providers.

You will audit records, articulate findings to investigators and leadership, stay current with CPT/HCPCS/ICD-10 guidelines, and contribute to fraud detection and cost savings while working full-time with a 40-hour week.

Qualifications

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

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS/modifier accuracy
• Provide written summaries of review findings
• Articulate findings to investigators, leadership and regulators
• Apply state and CMS guidelines with minimal support
• Identify potential billing errors, abuse or fraud
• Maintain records and comply with workflows to meet metrics
• Stay up-to-date on coding changes and reimbursement rules

Skills

Attention to detail

Communication skills

Analytical skills

Healthcare auditing

Education

GED or equivalent

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) to ensure coding accuracy and compliant documentation across medical, behavioral, transportation, and other healthcare providers.

You will audit records, articulate findings to investigators and leadership, stay current with CPT/HCPCS/ICD-10 guidelines, and contribute to fraud detection and cost savings while working full-time with a 40-hour week.