CPC-Certified Medical Coding Auditor (Compliance)

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

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will ensure coding accuracy, complete documentation, and adherence to state, federal, and company guidelines across medical, behavioral health, and transportation providers.

The CPC will audit CPT/HCPCS, discuss findings with Medical Directors, identify billing errors and opportunities for savings, and maintain thorough records while staying current on coding

Qualifications

• CPC certification and active credential.
• 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.
• Proficiency with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS or modifiers align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Apply state or CMS guidelines to audits with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research on coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Maintain meticulous records and documentation.
• Keep up-to-date coding knowledge and reimbursement changes.

Skills

Attention to detail

Communication skills

Analytical thinking

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 (SIU). You will ensure coding accuracy, complete documentation, and adherence to state, federal, and company guidelines across medical, behavioral health, and transportation providers.

The CPC will audit CPT/HCPCS, discuss findings with Medical Directors, identify billing errors and opportunities for savings, and maintain thorough records while staying current on coding