CPC Investigator: Medical Coding & Compliance Specialist

DaMar Staffing; Concord (NH); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Bonus eligibility

Competitive benefits

Job summary

CVS Health seeks a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding accuracy and compliance across medical, behavioral health, transportation, and other health care services. The CPC will determine correct coding and appropriate documentation, meeting state, federal and company requirements.

The role requires strong CPT, HCPCS, Revenue Codes, CMS 1500/UB04 knowledge, Excel proficiency, and the ability to travel for meetings or testimony as needed.

Qualifications

• AAPC CPC certification required.
• 3+ years of medical coding or documentation auditing experience.
• Strong knowledge of CPT, HCPCS, Revenue Codes, CMS 1500/UB04.
• Experience researching coding, state regulations and policies.
• Proficiency with Microsoft Excel.

Responsibilities

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

Skills

CPC Certification

Medical Coding

CPT/HCPCS Knowledge

Excel

Policy Research

Education

GED or equivalent

CPC Certification

Tools

Microsoft Excel

Job description

CVS Health seeks a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding accuracy and compliance across medical, behavioral health, transportation, and other health care services. The CPC will determine correct coding and appropriate documentation, meeting state, federal and company requirements.

The role requires strong CPT, HCPCS, Revenue Codes, CMS 1500/UB04 knowledge, Excel proficiency, and the ability to travel for meetings or testimony as needed.