CPC Coding Investigator — Medical & Behavioral Health

Istss; Atlanta (GA); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliance with state, federal, and company requirements. The role involves detailed documentation, collaboration with Medical Directors, and auditing of CPT/HCPCS/Revenue Codes.

Qualified candidates have at least 3 years of professional coding experience, CPC certification, and proficiency with Excel and Word. Travel is possible if needed.

Qualifications

• AAPC CPC certification and at least 3 years of medical coding experience.
• Experience with medical record review and documentation auditing.
• Knowledge of CPT/HCPCS/Revenue Codes and CMS guidelines.

Responsibilities

• Conduct comprehensive medical record reviews to verify coding accuracy.
• Provide written findings and articulate results to investigators and regulators.
• Identify billing errors, abuse, and fraud patterns.
• Maintain records and follow workflows to meet metrics.

Skills

CPC certification

Medical coding

Medical record review

CMS guidelines

Excel

Word

Education

GED or High School diploma

AAPC CPC Certification

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliance with state, federal, and company requirements. The role involves detailed documentation, collaboration with Medical Directors, and auditing of CPT/HCPCS/Revenue Codes.

Qualified candidates have at least 3 years of professional coding experience, CPC certification, and proficiency with Excel and Word. Travel is possible if needed.