CPC-Certified SIU Medical Coding Auditor

Istss; Santa Fe (NM); 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 SIU, ensuring coding accuracy and compliance with state and federal guidelines. This role involves detailed documentation, presenting findings to investigators and leadership, and identifying potential billing issues.

Qualified candidates hold CPC certification with 3+ years of coding experience, CPT/HCPCS expertise, and proficiency in Excel and Word. Travel may be required.

Qualifications

• CPC certification is required and 3+ years coding experience.
• Experience reviewing medical records and auditing documentation.
• Familiar with CPT/HCPCS and Revenue Codes and CMS 1500/UB04 elements.

Responsibilities

• Perform comprehensive medical record reviews to verify coding accuracy with supporting documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators and leadership; discuss with Medical Directors.
• Research and apply state or CMS guidelines with minimal support.
• Identify billing errors, potential abuse, or fraud and suggest savings.
• Maintain organized records and comply with workflows to meet metrics.

Skills

CPC certification

Medical coding experience

CPT/HCPCS knowledge

CMS 1500 & UB04 data elements

Excel

Word

Travel readiness

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 SIU, ensuring coding accuracy and compliance with state and federal guidelines. This role involves detailed documentation, presenting findings to investigators and leadership, and identifying potential billing issues.

Qualified candidates hold CPC certification with 3+ years of coding experience, CPT/HCPCS expertise, and proficiency in Excel and Word. Travel may be required.