CPC-Certified Medical Coding & Compliance Auditor

Voices for Voices; Richmond (VA); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Job summary

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit. The role ensures coding accuracy, proper documentation, and adherence to CMS and state guidelines while identifying potential fraud or billing errors.

You will review CPT/HCPCS codes, provide detailed findings, and communicate with investigators and regulators. The position requires CPC certification and 3+ years of coding experience, with travel as needed.

Qualifications

• 3+ years of medical and/or behavioral health coding experience, including record review and auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies and guidelines.
• Proficiency with Microsoft Excel and Word.
• Ability to travel if needed.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research CMS guidelines and state policies related to reviews.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Maintain records and follow workflows to meet metrics.
• Stay up-to-date on coding changes.

Skills

Medical coding

Auditing

Communication

Investigation

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit. The role ensures coding accuracy, proper documentation, and adherence to CMS and state guidelines while identifying potential fraud or billing errors.

You will review CPT/HCPCS codes, provide detailed findings, and communicate with investigators and regulators. The position requires CPC certification and 3+ years of coding experience, with travel as needed.