Certified Medical Coder & Compliance Auditor

Hispanic Alliance for Career Enhancement; New York (NY); Hybrid; USD 43,888 - 93,574; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and compliance with CPT/HCPCS, ICD-10, CMS 1500 and UB04 standards.

You will audit records, document findings and discuss cases with investigators, regulators and providers while staying current with coding guidelines and identifying potential billing errors, abuse or fraud and opportunities for savings.

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 researching coding and policies.
• Experience with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to ensure codes billed align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, regulators, providers and counsel.
• Research state or CMS guidelines related to audits.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud.
• Identify opportunities for savings related to potential cases.
• Maintain appropriate records and follow workflows to meet metrics.
• Maintain up-to-date coding knowledge including new changes to coding compliance.

Skills

Attention to detail

Communication skills

Analytical thinking

Education

GED or equivalent

AAPC CPC Certification

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and compliance with CPT/HCPCS, ICD-10, CMS 1500 and UB04 standards.

You will audit records, document findings and discuss cases with investigators, regulators and providers while staying current with coding guidelines and identifying potential billing errors, abuse or fraud and opportunities for savings.