CPC Investigator: Medical Coding & Compliance (SIU)

DaMar Staffing; South Mahoning Township (PA); On-site; USD 44,000 - 94,000; Full time

Job summary

CVS Health is hiring a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation. The ideal candidate has CPC credentials and 3+ years of coding or auditing experience, with strong Excel/Word skills.

Responsibilities include auditing medical records, summarizing findings, and communicating with investigators and regulators. This is a full-time position with comprehensive benefits.

Qualifications

• Must hold AAPC CPC certification and have hands-on experience auditing medical records.
• Strong knowledge of CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements.
• Experience with researching coding guidelines and policy interpretation.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS coding against documentation.
• Provide detailed written summaries of findings for investigations and leadership.
• Articulate findings to investigators, regulators and providers as needed.
• Apply state and CMS guidelines to audits with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify billing errors, abuse, and fraud; propose savings opportunities.
• Maintain documentation and follow established workflows.
• Keep up-to-date with coding changes and reimbursement policies.

Skills

CPC Certification

Medical coding

Auditing

CPT/HCPCS knowledge

MS Excel

MS Word

Education

CPC Certification (education)

Tools

Excel

Word

Job description

CVS Health is hiring a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation. The ideal candidate has CPC credentials and 3+ years of coding or auditing experience, with strong Excel/Word skills.

Responsibilities include auditing medical records, summarizing findings, and communicating with investigators and regulators. This is a full-time position with comprehensive benefits.