CPC Investigator — Medical Coding & Compliance Reviews

DaMar Staffing; Dover (DE); 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

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding accuracy and compliance across medical and behavioral health records. You will prepare detailed written findings and present them to investigators, leadership, and regulators while collaborating with Medical Directors to validate decisions.

Applicants should hold AAPC CPC certification, have 3+ years in medical coding or auditing, and be proficient in CPT, HCPCS, CMS 1500/UB04.

Qualifications

• AAPC CPC certification required.
• 3+ 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.
• Microsoft Excel experience required.

Responsibilities

• Conduct comprehensive medical record reviews to ensure billing aligns with the medical record.
• Provide detailed written summaries of findings.
• Articulate findings to investigators, regulators, leadership, and counsel.
• Review and discuss cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Identify savings opportunities for potential prepayment reviews.
• Maintain appropriate records and documentation.
• Travel for meetings and potential testimony.

Skills

Coding expertise

Audit experience

Excel proficiency

Communication skills

Analytical thinking

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 and compliance across medical and behavioral health records. You will prepare detailed written findings and present them to investigators, leadership, and regulators while collaborating with Medical Directors to validate decisions.

Applicants should hold AAPC CPC certification, have 3+ years in medical coding or auditing, and be proficient in CPT, HCPCS, CMS 1500/UB04.