CPC Investigator: Medical Coding & Compliance

The Mississippi Bar; Jackson (MS); Hybrid; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for coding accuracy across medical, behavioral, and other healthcare records. The CPC will ensure compliance with CPT, HCPCS, CMS 1500, and UB04 requirements while identifying billing patterns.

The role requires 3+ years of coding or documentation auditing, AAPC CPC, strong Excel skills, and travel for meetings as needed; base pay range is $43,888 to $102,081 with eligibility for bonus.

Qualifications

• CPC certification required and three or more years in medical coding or documentation auditing.
• 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.
• Explain 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.

Skills

CPC certification

3+ years experience

CPT/HCPCS knowledge

CMS 1500 & UB04

Excel proficiency

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 for coding accuracy across medical, behavioral, and other healthcare records. The CPC will ensure compliance with CPT, HCPCS, CMS 1500, and UB04 requirements while identifying billing patterns.

The role requires 3+ years of coding or documentation auditing, AAPC CPC, strong Excel skills, and travel for meetings as needed; base pay range is $43,888 to $102,081 with eligibility for bonus.