CPC Specialist - SIU Medical & Behavioral Health Auditor

CVS Health Corporation; Frankfort (KY); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Paid time off

Job summary

CVS Health Corporation is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role involves determining correct coding, ensuring documentation adequacy, and ensuring compliance with state, federal, and company guidelines.

The position requires 3+ years of coding experience, CPC certification, knowledge of CPT/HCPCS, and CMS guidelines, with potential travel as needed.

Qualifications

• AAPC CPC certification.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes and modifiers align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research and apply state or CMS guidelines.
• Review cases with Medical Directors to validate decisions.
• Assist with coding audit and fraud-related investigations.
• Identify potential billing errors, abuse, and fraud.
• Maintain records and documentation.
• Follow workflows to meet metrics.

Skills

AAPC CPC certification

3+ years in medical/behavioral health

Medical record review

CPT, HCPCS, Revenue Codes knowledge

CMS 1500 and UB04 data elements

Excel and Word

Ability to travel

Education

AAPC CPC Certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health Corporation is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role involves determining correct coding, ensuring documentation adequacy, and ensuring compliance with state, federal, and company guidelines.

The position requires 3+ years of coding experience, CPC certification, knowledge of CPT/HCPCS, and CMS guidelines, with potential travel as needed.