Medical Coding & Compliance Analyst (CPC)

Voices for Voices; Jefferson City (MO); Hybrid; USD 44,000 - 94,000; 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 join our Special Investigations Unit. You will conduct comprehensive medical record reviews, ensure CPT/HCPCS coding accuracy, and document findings for investigators and regulators.

Ideal candidates have 3+ years in medical coding, CPC certification, and experience with CMS 1500/UB04 data elements. This full-time role offers a broad benefits package and opportunities to impact healthcare quality and compliance.

Qualifications

• AAPC CPC certification required.
• 3+ years of medical or behavioral health coding experience.
• Experience with medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Proficiency with Microsoft Excel and Word.
• Ability to travel if needed.

Responsibilities

• Perform comprehensive medical record reviews to verify CPT/HCPCS/Revenue code accuracy.
• Provide detailed written summaries of review findings.
• Communicate findings to investigators, leadership, and regulators.
• Apply state/CMS guidelines to reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with coding-related investigative research.
• Identify potential billing errors, abuse and fraud.
• Identify opportunities for savings warranting prepayment review.
• Maintain organized records and documentation.
• Follow workflows to meet performance metrics.

Skills

CPC certification

Medical record review

CPT/HCPCS knowledge

CMS 1500/UB04

Documentation auditing

Microsoft Excel/Word

Willingness to travel

Education

CPC certification

GED or High School diploma

Tools

CMS guidelines

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to join our Special Investigations Unit. You will conduct comprehensive medical record reviews, ensure CPT/HCPCS coding accuracy, and document findings for investigators and regulators.

Ideal candidates have 3+ years in medical coding, CPC certification, and experience with CMS 1500/UB04 data elements. This full-time role offers a broad benefits package and opportunities to impact healthcare quality and compliance.