CPC SIU Medical & Behavioral Health Coding Investigator

Preferra Insurance; Boise (ID); Híbrido; USD 44 000 - 94 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Comprehensive benefits

Bonus program

Resumo da oferta

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation across medical, behavioral health, transportation and other health services.

The role requires 3+ years of professional coding and record review, CPC certification, and proficiency with CPT/HCPCS, CMS guidelines, and MS Office. Travel may be required to support investigations and training.

Qualificações

• AAPC CPC certification required.
• Minimum of 3 years of medical/behavioral health coding experience, including record review and auditing.
• Knowledge of CPT, HCPCS, Revenue Codes and CMS 1500/UB04 data elements.
• Proficiency with Microsoft Office (Excel, Word).
• Ability to travel as needed.

Responsabilidades

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/revenue code accuracy.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators as needed.
• Research and apply state or CMS guidelines with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse and fraud.
• Maintain accurate records and documentation.

Conhecimentos

CPC certification

Medical coding

Auditing

Communication

Microsoft Excel

Travel readiness

Formação académica

AAPC CPC certification

GED or high school diploma

Ferramentas

Excel

Word

CMS 1500 UB04 data elements

Descrição da oferta de emprego

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation across medical, behavioral health, transportation and other health services.

The role requires 3+ years of professional coding and record review, CPC certification, and proficiency with CPT/HCPCS, CMS guidelines, and MS Office. Travel may be required to support investigations and training.