CPC Auditor - Special Investigations Unit

Colorado Psychiatric; Colorado; On-site; USD 44,000 - 94,000; Full time

Job summary

CVS Health is hiring a Certified Professional Coder (CPC) for the Special Investigations Unit to perform medical claim reviews and ensure coding compliance. You will audit records, identify improper coding, and communicate findings to investigators, leadership, and regulators.

Requirements include CPC certification, 3+ years in medical coding or auditing, and proficiency with CPT/HCPCS, ICD-10, CMS 1500 and UB04. Strong Excel/Word skills are needed.

Qualifications

• CPC certification and minimum 3 years of medical coding or auditing experience.
• Knowledge of CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements.
• Experience researching coding policies and guidelines.
• Proficiency with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS or modifiers align with documentation.
• Provide written summaries of audit findings.
• Explain findings to investigators, plan leadership, and regulators as needed.
• Apply state or CMS guidelines to audits with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify billing errors, abuse, and potential fraud; suggest prepayment savings.

Skills

CPC Certification

3+ years experience

CPT/HCPCS guidance

MS Excel

MS Word

Education

AAPC CPC

Tools

Excel

Word

Job description

CVS Health is hiring a Certified Professional Coder (CPC) for the Special Investigations Unit to perform medical claim reviews and ensure coding compliance. You will audit records, identify improper coding, and communicate findings to investigators, leadership, and regulators.

Requirements include CPC certification, 3+ years in medical coding or auditing, and proficiency with CPT/HCPCS, ICD-10, CMS 1500 and UB04. Strong Excel/Word skills are needed.