Medical Coding & Compliance Auditor (CPC)

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

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will audit records to ensure coding accuracy and compliance with CPT/HCPCS, ICD-10, and CMS 1500/UB04 elements.

This full-time role requires 3+ years in medical coding or documentation auditing, CPC certification, strong attention to detail, and the ability to communicate findings to investigators and leadership.

Qualifications

• 3+ years of experience in medical coding or documentation auditing.
• Knowledge of CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements.

Responsibilities

• Conduct a comprehensive medical record audit to ensure CPT/HCPCS or modifiers billed are consistent with documentation.
• Provide detailed written summary of medical record review findings.
• Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.
• Identify potential billing errors, abuse, and fraud.
• Maintain appropriate records, files and documentation.
• Maintain up-to-date coding knowledge, including new changes to coding compliance and reimbursement.

Skills

Attention to detail

Communication skills

Analytical skills

Education

GED or equivalent

AAPC Certification CPC

Tools

Excel

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 audit records to ensure coding accuracy and compliance with CPT/HCPCS, ICD-10, and CMS 1500/UB04 elements.

This full-time role requires 3+ years in medical coding or documentation auditing, CPC certification, strong attention to detail, and the ability to communicate findings to investigators and leadership.