CPC Investigator: Medical Coding & Compliance Specialist

DaMar Staffing; Montgomery (AL); On-site; USD 61,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews and ensure coding accuracy across medical, behavioral, transportation and other healthcare services.

The CPC will document findings, communicate with investigators, regulators and stakeholders, and collaborate with Medical Directors to validate decisions. The role requires strong CPT/HCPCS knowledge, Excel proficiency, and the ability to travel as needed.

Qualifications

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

Responsibilities

• Conduct 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 which may warrant a prepayment review.
• Maintain appropriate records, files, documentation, etc.
• Ability to travel for meetings and potential to testify.

Skills

Medical coding

Auditing

Excel proficiency

Education

GED or equivalent

AAPC CPC Certification

Tools

CPT/HCPCS guidelines

CMS 1500 & UB04

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews and ensure coding accuracy across medical, behavioral, transportation and other healthcare services.

The CPC will document findings, communicate with investigators, regulators and stakeholders, and collaborate with Medical Directors to validate decisions. The role requires strong CPT/HCPCS knowledge, Excel proficiency, and the ability to travel as needed.