CPC SIU Medical Coding & Compliance Analyst

Preferra Insurance; City of Albany (NY); Hybrid; USD 44.000 - 94.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Zusammenfassung

CVS Health is seeking a Certified Professional Coder (CPC) to support the Special Investigations Unit. The role requires 3+ years of medical and/or behavioral health coding experience, with strong record review and auditing skills, and proficiency in CPT, HCPCS, and Revenue Codes.

The CPC will review medical records, document findings, and articulate results to investigators, leadership, and regulators. Travel may be required; familiarity with CMS guidelines is a plus.

Qualifikationen

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

Aufgaben

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Explain findings to investigators, leadership, and regulators as needed.
• Research and apply state or CMS guidelines with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Identify savings opportunities for prepayment review cases.
• Maintain records and documentation; follow workflows to meet metrics.
• Keep up-to-date coding knowledge with changes in compliance and reimbursement.

Kenntnisse

CPC certification

Medical coding

CMS 1500 / UB04

Record review

Auditing

Microsoft Excel

Communication

Ausbildung

AAPC CPC Certification

GED or High School diploma

Tools

Excel

Word

Jobbeschreibung

CVS Health is seeking a Certified Professional Coder (CPC) to support the Special Investigations Unit. The role requires 3+ years of medical and/or behavioral health coding experience, with strong record review and auditing skills, and proficiency in CPT, HCPCS, and Revenue Codes.

The CPC will review medical records, document findings, and articulate results to investigators, leadership, and regulators. Travel may be required; familiarity with CMS guidelines is a plus.