Medical Coding & Compliance Auditor

Hispanic Alliance for Career Enhancement; Arizona; Hybrid; USD 43,888 - 93,574; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring compliant coding and documentation across medical, behavioral health, transportation, and other services. The role requires auditing current records, communicating findings to investigators and regulators, and staying up-to-date on coding guidelines.

The ideal candidate has CPC certification, 3+ years of coding or auditing experience, proficiency with CPT/HCPCS/ICD-10 and CMS

Qualifications

• AAPC Certified Professional Coder (CPC)
• 3+ years of medical coding or documentation auditing experience
• Knowledge of CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements
• Experience with researching coding and policies
• Experience with Microsoft Excel and Word

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS or modifiers billed align with documentation.
• Provide detailed written summaries of audit findings.
• Articulate findings to investigators, Medicaid leadership, law enforcement, and other stakeholders.
• Research and apply state or CMS guidelines related to audits.
• 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.
• Identify savings opportunities that may warrant prepayment review.
• Maintain records and documentation; follow workflows to meet metrics.
• Maintain up-to-date coding knowledge, including changes to coding compliance and reimbursement.

Skills

CPC certification

Attention to detail

Excellent communication

Researching coding policies

Education

GED or equivalent

AAPC CPC Certification

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring compliant coding and documentation across medical, behavioral health, transportation, and other services. The role requires auditing current records, communicating findings to investigators and regulators, and staying up-to-date on coding guidelines.

The ideal candidate has CPC certification, 3+ years of coding or auditing experience, proficiency with CPT/HCPCS/ICD-10 and CMS