Certified Professional Coder: Audit & Compliance Specialist

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

Benefits offered by this job

Medical, dental, vision coverage

Retirement savings options

Paid time off

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.

The CPC must articulate findings to investigators, regulators, and leadership, and support efforts to identify billing errors, abuse, and fraud while maintaining documentation and up-to-date coding knowledge.

Qualifications

• AAPC CPC certification is required.
• 3+ years of medical coding or documentation auditing experience.
• Knowledge of CPT/HCPCS/ICD-10, CMS 1500 and UB04 data elements.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS or modifiers align with documentation.
• Provide detailed written summaries of audit findings.
• Articulate findings to investigators, Medicaid leadership, law enforcement, and regulators.

Skills

CPC Certification

3+ years experience

CPT/HCPCS/ICD-10 knowledge

Researching coding policies

Excel

Word

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.

The CPC must articulate findings to investigators, regulators, and leadership, and support efforts to identify billing errors, abuse, and fraud while maintaining documentation and up-to-date coding knowledge.