Certified Medical Coding & Audit Specialist

DaMar Staffing; Columbus (OH); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical insurance

Paid time off

Retirement plan

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews and ensure coding accuracy across medical, behavioral health, transportation, and other healthcare domains. The role requires determining correct coding, documenting findings, and ensuring compliance with state, federal, and company policies.

Responsibilities include detailed record reviews, communicating findings to various stakeholders, collaborating with Medical Directors, and identifying potential

Qualifications

• AAPC Coding certification is required.
• Certified Professional Coder (CPC) certification.
• 3+ years of experience in medical coding or documentation auditing.

Responsibilities

• Conduct a comprehensive medical record review to ensure billing is consistent with medical records.
• Provide detailed written summary of medical record review findings.
• Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.
• Review and discuss cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions, state and federal policies.
• Identify potential billing errors, abuse, and fraud.
• Identify opportunities for savings related to potential cases which may warrant a prepayment review.
• Maintain appropriate records, files, documentation, etc.
• Ability to travel for meetings and potential to testify.

Education

GED or equivalent

AAPC Certified Professional Coder Certification (CPC)

Tools

Microsoft Excel

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews and ensure coding accuracy across medical, behavioral health, transportation, and other healthcare domains. The role requires determining correct coding, documenting findings, and ensuring compliance with state, federal, and company policies.

Responsibilities include detailed record reviews, communicating findings to various stakeholders, collaborating with Medical Directors, and identifying potential