CPC-Certified SIU Health Coding Auditor

Preferra Insurance; Harrisburg (Dauphin County); Presencial; USD 44.000 - 94.000; Jornada completa

Descripción de la vacante

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding and documentation compliance across medical, behavioral health, and related services. You will identify billing anomalies and communicate findings to investigators and leadership.

Required CPC certification and 3+ years of coding and record-review experience; travel may be required. Competitive benefits and a focus on accuracy and integrity underpin this full-time role.

Formación

• AAPC CPC certification required.
• 3+ years of medical/behavioral health coding experience.
• Knowledge of CPT, HCPCS and Revenue Codes.
• CMS 1500 and UB04 data elements knowledge.
• Ability to interpret and apply coding policies consistently.
• Experience with Microsoft Excel and Word.

Responsabilidades

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/modifier accuracy.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Apply state or CMS guidelines with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with coding questions and investigations related to fraud.
• Identify billing errors and potential savings opportunities.
• Maintain records and documentation and follow workflows to meet metrics.
• Stay updated on coding changes to ensure compliance.

Conocimientos

Medical coding

Record review

Documentation auditing

CPT/HCPCS knowledge

CMS guidelines

Educación

AAPC CPC certification

GED or High School diploma

Herramientas

Excel

Word

CMS 1500/UB04 elements

Descripción del empleo

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding and documentation compliance across medical, behavioral health, and related services. You will identify billing anomalies and communicate findings to investigators and leadership.

Required CPC certification and 3+ years of coding and record-review experience; travel may be required. Competitive benefits and a focus on accuracy and integrity underpin this full-time role.