Healthcare Coding Investigator & Compliance Analyst

Voices for Voices; Santa Fe (NM); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will ensure coding accuracy, apply CPT/HCPCS codes, and verify documentation while adhering to state, federal, and company guidelines.

Responsibilities include detailed written summaries, collaboration with Medical Directors, and identification of potential billing errors, abuse, or fraud. 40 hours/week, full-time, with competitive benefits.

Qualifications

• Requires CPC certification and 3+ years of medical/behavioral health coding experience.
• Must be able to review medical records and apply CPT/HCPCS/Revenue codes accurately.
• Knowledge of CMS 1500 and UB04 data elements and coding guidelines.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/revenue codes align with documentation.
• Provide detailed written findings and communicate results to investigators and leadership.
• Research state or CMS guidelines related to reviews with minimal support.
• Review cases with Medical Directors to validate decisions and discuss findings.
• Identify billing errors, abuse or fraud, and opportunities for savings needing prepayment review.
• Maintain comprehensive records and adhere to workflows to meet metrics.

Skills

CPC certification

Medical coding experience

Documentation auditing

CMS 1500/UB04 knowledge

Travel ability

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will ensure coding accuracy, apply CPT/HCPCS codes, and verify documentation while adhering to state, federal, and company guidelines.

Responsibilities include detailed written summaries, collaboration with Medical Directors, and identification of potential billing errors, abuse, or fraud. 40 hours/week, full-time, with competitive benefits.