CPC: Special Investigations Auditor

CVS Health; Frankfort (KY); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform comprehensive medical record reviews and ensure coding accuracy in healthcare claims. The role includes detailing review findings, discussing cases with Medical Directors, and supporting investigations related to coding questions and state regulations.

The position requires CPC certification, 3+ years of medical coding or auditing experience, and strong Excel and regulatory research skills. Travel may be required.

Qualifications

• AAPC CPC certification required.
• 3+ years of medical coding or documentation auditing.
• Strong knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements.
• Experience researching coding, state regulations and policies.
• Working experience with Microsoft Excel.

Responsibilities

• Conduct comprehensive medical record reviews to ensure billing is consistent with records.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, Medicaid plan leadership, and regulators.
• Review and 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 that may warrant prepayment review.
• Maintain appropriate records and documentation.
• Travel for meetings and potential testimony.

Skills

CPC certification

Medical coding

Auditing

Excel

Regulatory research

Communication

Data interpretation

Education

GED or equivalent

AAPC CPC Certification

Tools

Microsoft Excel

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform comprehensive medical record reviews and ensure coding accuracy in healthcare claims. The role includes detailing review findings, discussing cases with Medical Directors, and supporting investigations related to coding questions and state regulations.

The position requires CPC certification, 3+ years of medical coding or auditing experience, and strong Excel and regulatory research skills. Travel may be required.