CPC Investigator – Healthcare Coding & Compliance

DaMar Staffing; Jackson (MS); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Certified ProfessionalCoder (CPC) to perform medical claim reviews ensuring coding accuracy and compliance with state and federal requirements.

The role involves comprehensive record reviews across medical, behavioral health, and transportation services, with opportunities to testify and travel as needed. A CPC certification, 3+ years of coding/auditing experience, and strong Excel skills are required.

Qualifications

• 3+ years of experience in medical coding or documentation auditing.
• AAPC/CPC certification required.
• Strong knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements.

Responsibilities

• Conduct comprehensive medical record reviews to ensure billing aligns with the medical record.
• Provide written summaries of review findings and articulate results to stakeholders.
• Review cases with Medical Directors to validate decisions and assist with policy research.
• Identify billing errors, potential abuse or fraud and opportunities for savings via prepayment review.

Skills

Medical coding

Auditing

Excel

Education

GED or equivalent

AAPC CPC Certification

Tools

CMS 1500 forms

UB04 data elements

Job description

CVS Health is seeking a Certified ProfessionalCoder (CPC) to perform medical claim reviews ensuring coding accuracy and compliance with state and federal requirements.

The role involves comprehensive record reviews across medical, behavioral health, and transportation services, with opportunities to testify and travel as needed. A CPC certification, 3+ years of coding/auditing experience, and strong Excel skills are required.