CPC-Certified SIU Medical Coding & Compliance Analyst

CVS Health Corporation; Saint Paul (MN); Vor Ort; USD 44.000 - 94.000; Vollzeit

Zusammenfassung

CVS Health Corporation is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will ensure coding accuracy, prepare detailed review summaries, and communicate findings to investigators and state regulators.

The role requires CPT/HCPCS knowledge, CMS 1500/UB04 familiarity, and the ability to travel as needed. The position emphasizes strict adherence to coding policies, up-to-date knowledge, and collaboration with Medical

Qualifikationen

• AAPC CPC certification required.
• 3+ years in medical/behavioral health coding; 1-2 years current coding exp.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies consistently.
• Experience with Microsoft Word and Excel.
• Willingness and ability to travel as needed.

Aufgaben

• Conduct comprehensive medical record reviews to ensure correct CPT/HCPCS/Revenue codes and modifiers align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research state or CMS guidelines related to reviews.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research on coding questions and policies.
• Identify possible billing errors, abuse and fraud.
• Maintain records and meet metrics; follow workflows.

Kenntnisse

CPC certification

Medical coding

CPT/HCPCS knowledge

Revenue codes

CMS 1500/UB04

Excel

Travel readiness

Ausbildung

AAPC CPC certification

GED or High School diploma

Tools

MS Word

Microsoft Excel

Jobbeschreibung

CVS Health Corporation is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will ensure coding accuracy, prepare detailed review summaries, and communicate findings to investigators and state regulators.

The role requires CPT/HCPCS knowledge, CMS 1500/UB04 familiarity, and the ability to travel as needed. The position emphasizes strict adherence to coding policies, up-to-date knowledge, and collaboration with Medical