CPC SIU Medical & Behavioral Health Coding Auditor

Istss; Charleston (WV); Hybride; USD 44 000 - 94 000; Plein temps

Avantages offerts par ce poste

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Résumé du poste

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will ensure coding accuracy and proper documentation during medical record reviews, while complying with state, federal, and company requirements.

You will review CPT/HCPCS codes, educate investigators, identify fraud indicators, and maintain thorough documentation. 40-hour work week with eligibility for CVS benefits and incentive programs.

Qualifications

• AAPC CPC certification required.
• Minimum 3 years of medical/behavioral health coding experience with 1–2 years of current professional coding experience.
• Knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies and guidelines.
• Proficiency with Excel and Word.

Responsabilités

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research CMS/state guidelines related to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify billing errors, abuse, and fraud and opportunities for savings.
• Maintain records and follow workflows to meet metrics.

Connaissances

CPC certification

Medical coding

Record review

Documentation auditing

Microsoft Excel

Microsoft Word

Formation

AAPC CPC Certification

GED or High School diploma

Outils

Microsoft Excel

Microsoft Word

Description du poste

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will ensure coding accuracy and proper documentation during medical record reviews, while complying with state, federal, and company requirements.

You will review CPT/HCPCS codes, educate investigators, identify fraud indicators, and maintain thorough documentation. 40-hour work week with eligibility for CVS benefits and incentive programs.