Certified Professional Coder - Investigations & Compliance

DaMar Staffing; Olympia (WA); On-site; USD 44,000 - 102,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews and ensure coding compliance across medical records, behavioral health, and other healthcare services.

The CPC will determine correct coding, ensure documentation meets state, federal and company requirements, and identify billing patterns or fraud. Travel for meetings and potential testimony may be required.

Qualifications

• Must have AAPC CPC certification.
• 3+ years of experience in medical coding or documentation auditing.
• Strong knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements.
• Experience researching coding, state regulations and policies.
• Working experience with Microsoft Excel.
• Excellent communication and attention to detail.

Responsibilities

• Conduct comprehensive medical record reviews to ensure billing is consistent with medical records.
• Provide detailed written summaries 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.

Skills

Analytical skills

Communication skills

Attention to detail

Microsoft Excel

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 and ensure coding compliance across medical records, behavioral health, and other healthcare services.

The CPC will determine correct coding, ensure documentation meets state, federal and company requirements, and identify billing patterns or fraud. Travel for meetings and potential testimony may be required.