Medical Claims Coding Investigator & Audit Specialist

DaMar Staffing; Augusta (ME); 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 medical claim reviews ensuring coding accuracy across medical records. The role requires evaluating documentation, adhering to CPT/HCPCS rules, and communicating findings to stakeholders.

Applicants should have 3+ years of coding/auditing experience, CPC certification, and strong Excel skills. This full-time position offers a comprehensive benefits package and opportunities for travel and testimony.

Qualifications

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

Responsibilities

• Perform comprehensive medical record reviews to ensure billing aligns with records.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, Medicaid leadership, and regulators.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud; flag opportunities for savings.
• Maintain meticulous records and documentation.
• Travel for meetings and potential testimony.

Skills

CPC Certification

Medical coding

Documentation auditing

CPT/HCPCS knowledge

Microsoft Excel

Regulatory research

Education

GED or equivalent

AAPC CPC Certification

Tools

CMS 1500 forms

UB04 data elements

CMS Guidelines

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding accuracy across medical records. The role requires evaluating documentation, adhering to CPT/HCPCS rules, and communicating findings to stakeholders.

Applicants should have 3+ years of coding/auditing experience, CPC certification, and strong Excel skills. This full-time position offers a comprehensive benefits package and opportunities for travel and testimony.