CPC Medical & Behavioral Health Coding Investigator

CVS Health Corporation; Des Moines (IA); Presencial; USD 44 000 - 94 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Bonus program

Benefits package

Resumo da oferta

CVS Health Corporation is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will verify CPT/HCPCS/revenue code alignment with documentation and ensure compliance with state, federal and corporate guidance, flagging potential fraud or errors.

Ideal candidates hold AAPC CPC certification with at least 3 years of medical or behavioral health coding experience, including record review and documentation auditing.

Qualificações

• AAPC CPC certification required.
• Minimum of 3 years of medical/behavioral health coding experience with record review and auditing.
• Knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies and guidelines.
• Experience with Excel and Word.

Responsabilidades

• Conduct comprehensive medical record reviews to verify coding accuracy against documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research and apply state or CMS guidelines with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify billing errors, abuse, and fraud and potential savings.
• Maintain records and follow daily workflows to meet metrics.
• Stay current with coding changes and reimbursement rules.

Conhecimentos

Medical coding experience

Record review

Documentation auditing

Verbal and written communication

Formação académica

AAPC CPC certification

GED or High School diploma

Ferramentas

Excel

Word

Descrição da oferta de emprego

CVS Health Corporation is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will verify CPT/HCPCS/revenue code alignment with documentation and ensure compliance with state, federal and corporate guidance, flagging potential fraud or errors.

Ideal candidates hold AAPC CPC certification with at least 3 years of medical or behavioral health coding experience, including record review and documentation auditing.