CPC Investigator — Medical Coding & Compliance

DaMar Staffing; Richmond (VA); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Health benefits

Retirement plan

Paid time off

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding compliance across multiple service areas. The CPC will determine correct coding, review documentation, and ensure adherence to state, federal, and company policies while communicating findings to stakeholders.

Required CPC certification and at least 3 years of coding or auditing experience; proficiency with CPT/HCPCS, CMS 1500, UB04 and Excel is essential.

Qualifications

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

Responsibilities

• Conduct a comprehensive medical record review to ensure billing is consistent with medical record.
• Provide detailed written summary of medical record review findings.
• Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.
• Review and discuss cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions, state and federal policies.
• Identify potential billing errors, abuse, and fraud.
• Identify opportunities for savings related to potential cases warranting a prepayment review.
• Maintain records and documentation.
• Ability to travel for meetings and potential testimony.

Skills

CPC Certification

Medical coding

Excel

Education

GED

AAPC CPC

Tools

Excel

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding compliance across multiple service areas. The CPC will determine correct coding, review documentation, and ensure adherence to state, federal, and company policies while communicating findings to stakeholders.

Required CPC certification and at least 3 years of coding or auditing experience; proficiency with CPT/HCPCS, CMS 1500, UB04 and Excel is essential.