Certified Medical Coder – Investigations & Compliance

DaMar Staffing; Sacramento (CA); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding compliance across medical, behavioral, transportation and other healthcare contexts. The CPC reviews records to determine correct coding and documentation while meeting state, federal and company requirements and spotting concerning billing patterns.

Responsibilities include conducting full medical record reviews, providing detailed findings, communicating with investigators and

Qualifications

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

Responsibilities

• Conduct comprehensive medical record reviews to ensure billing aligns with the record.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, regulators, and stakeholders.
• Discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Travel for meetings and potential testimony.

Skills

Medical coding

Auditing experience

Excel proficiency

Communication skills

Education

GED or equivalent

AAPC CPC Certification

Tools

Microsoft Excel

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding compliance across medical, behavioral, transportation and other healthcare contexts. The CPC reviews records to determine correct coding and documentation while meeting state, federal and company requirements and spotting concerning billing patterns.

Responsibilities include conducting full medical record reviews, providing detailed findings, communicating with investigators and