CPC Investigator - Healthcare Coding & Compliance

DaMar Staffing; Cheyenne (WY); On-site; USD 61,000 - 102,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Wellness programs

Retirement savings

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding accuracy across medical, behavioral health, transportation and other services. You will determine correct coding and documentation during record reviews, ensuring compliance with state, federal and company policies, and identify billing patterns that require attention.

Responsibilities include conducting comprehensive chart reviews, providing detailed written findings, and communicating

Qualifications

• AAPC CPC certification required and maintained.
• 3+ years of medical coding or documentation auditing experience.
• Strong knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements.
• Experience researching coding rules, state regulations and policies.
• Proficiency with Microsoft Excel.

Responsibilities

• Perform comprehensive medical record reviews to ensure billing aligns with the medical record.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, Medicaid leadership, and other stakeholders.
• Review cases with Medical Directors to validate coding decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse and fraud.
• Identify savings opportunities that may warrant prepayment review.
• Maintain records and documentation; travel for meetings/testimony as needed.

Skills

CPC Certification

Medical coding experience

CPT/HCPCS knowledge

CMS 1500/UB04 knowledge

Education

GED or equivalent

AAPC CPC Certification

Tools

Microsoft Excel

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding accuracy across medical, behavioral health, transportation and other services. You will determine correct coding and documentation during record reviews, ensuring compliance with state, federal and company policies, and identify billing patterns that require attention.

Responsibilities include conducting comprehensive chart reviews, providing detailed written findings, and communicating