CPC Medical Coding Auditor – SIU & Behavioral Health

CVS Health Corporation; Madison (WI); Sur place; USD 56 000 - 94 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

Résumé du poste

CVS Health seeks a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding compliance. You will review medical records for CPT/HCPCS and Revenue codes, document findings, and communicate findings to investigators, leadership, and regulators.

Travel may be required to support cases and audits. Required CPC certification with 3+ years of coding experience, including record review, and proficiency in CPT/HCPCS, CMS 1500, and

Qualifications

• AAPC CPC certification; minimum 3 years in medical/behavioral health coding with 1–2 years in professional coding and record review.
• Knowledge of CPT, HCPCS, Revenue Codes; CMS 1500 and UB04 data elements.
• Proficiency with Microsoft Office; ability to travel if needed.

Responsabilités

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue code accuracy against documentation.
• Provide detailed written summaries of review findings for investigators and leadership.
• Articulate findings to investigators, plan leadership, law enforcement, legal counsel, providers, and regulators.

Connaissances

Attention to detail

Written and verbal communication

Analytical thinking

Team collaboration

Formation

AAPC CPC certification

GED or High School diploma

Outils

Excel

Word

Description du poste

CVS Health seeks a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding compliance. You will review medical records for CPT/HCPCS and Revenue codes, document findings, and communicate findings to investigators, leadership, and regulators.

Travel may be required to support cases and audits. Required CPC certification with 3+ years of coding experience, including record review, and proficiency in CPT/HCPCS, CMS 1500, and