CPC Investigator: Medical Coding & Compliance

DaMar Staffing; Baton Rouge (LA); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform detailed medical claim reviews, ensuring coding accuracy across medical and behavioral health records. The role requires articulating findings to investigators, leadership, and regulators, and collaborating with Medical Directors to validate decisions.

The position emphasizes strong CPT/HCPCS knowledge, auditing experience, and proficiency with Excel.

Qualifications

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

Responsibilities

• Conduct comprehensive medical record reviews to ensure billing aligns with the medical record.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, plan leadership, regulators and providers.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud and opportunities for savings.
• Maintain thorough records and documentation.
• Travel for meetings and potential testimony.

Skills

CPC certification

Medical coding

Excel

Education

GED or equivalent

AAPC CPC Certification

Tools

Microsoft Excel

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform detailed medical claim reviews, ensuring coding accuracy across medical and behavioral health records. The role requires articulating findings to investigators, leadership, and regulators, and collaborating with Medical Directors to validate decisions.

The position emphasizes strong CPT/HCPCS knowledge, auditing experience, and proficiency with Excel.