Certified Professional Coder – Medical Claims Audit

Hispanic Alliance for Career Enhancement; Town of Vermont (WI); Hybrid; USD 43,888 - 93,574; Full time

Benefits offered by this job

Comprehensive benefits

Bonus program

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The CPC will audit medical records for proper CPT/HCPCS coding and documentation, ensuring compliance with state, federal, and company guidelines.

Strong communication and analytical skills are essential to articulate findings to investigators and regulators. The role requires 3+ years of coding experience, CPC certification, and knowledge of CPT/HCPCS, ICD-10,

Qualifications

• 3+ years of medical coding or documentation auditing.
• Knowledge of CPT/HCPCS, ICD-10, CMS 1500 and UB04 data elements.
• Experience researching coding and policies.
• Excellent communication skills.
• Strong attention to detail.

Responsibilities

• Audit medical records to verify CPT/HCPCS or modifiers match documentation.
• Provide written summaries of audit findings.
• Explain findings to investigators, leadership, and regulators.
• Research state or CMS guidelines with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigations related to coding questions and policies.
• Identify potential billing errors, abuse or fraud.
• Identify savings opportunities for potential prepayment review.
• Maintain accurate records and files.
• Follow workflows to meet metrics and stay updated on coding changes.

Skills

3+ years of medical coding experience

Attention to detail

Strong communication skills

Researching coding policies

Education

AAPC CPC Certification

GED or equivalent

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The CPC will audit medical records for proper CPT/HCPCS coding and documentation, ensuring compliance with state, federal, and company guidelines.

Strong communication and analytical skills are essential to articulate findings to investigators and regulators. The role requires 3+ years of coding experience, CPC certification, and knowledge of CPT/HCPCS, ICD-10,