CPC Special Investigations Auditor – Medical Coding

DaMar Staffing; Columbus (OH); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Retirement savings options

Paid time off

Job summary

CVS Health in the United States seeks a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding accuracy and compliance with state, federal, and company policies. The CPC will summarize findings, discuss cases with Medical Directors, and assist with investigations.

Travel may be required, and 40 hours per week is anticipated. The ideal candidate holds CPC certification, 3+ years of medical coding or auditing experience, and proficiency with CPT/HCPCS, CMS 1500, UB04,

Qualifications

• CPC certification required (AAPC CPC).
• 3+ years of medical coding or documentation auditing experience.
• Strong knowledge of CPT, HCPCS, Revenue Codes, CMS 1500/UB04.

Responsibilities

• Perform comprehensive medical record reviews to ensure billing aligns with the medical record.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, Medicaid leadership, and regulators as needed.
• Review cases with Medical Directors to validate decisions.
• Identify billing errors, abuse or fraud and opportunities for savings.
• Maintain organized records and documentation.
• Willingness to travel for meetings and testimony.

Skills

CPC Certification

Medical coding experience

Analytical skills

Communication skills

Attention to detail

Education

GED or equivalent

AAPC CPC Certification

Tools

Microsoft Excel

Job description

CVS Health in the United States seeks a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding accuracy and compliance with state, federal, and company policies. The CPC will summarize findings, discuss cases with Medical Directors, and assist with investigations.

Travel may be required, and 40 hours per week is anticipated. The ideal candidate holds CPC certification, 3+ years of medical coding or auditing experience, and proficiency with CPT/HCPCS, CMS 1500, UB04,