Senior Behavioral Health Coding Auditor & Compliance Expert

Preferra Insurance; Hartford (CT); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical insurance

Dental and vision coverage

Paid time off

Retirement plan

Job summary

CVS Health is seeking a detail-oriented Medical Coding Auditor to conduct comprehensive reviews of behavioral health records and ensure CPT/HCPCS accuracy. You will audit complex cases, articulate findings to investigators and leadership, and mentor junior coders in a fast-paced environment at our Hartford area location.

Required CPC certification and 3+ years of behavioral health coding or audits; strong knowledge of CPT/HCPCS/ICD-10, CMS 1500/UB04, and MS Office. Travel may be required.

Qualifications

• CPC certification required.
• 3+ years in Behavioral Health coding or documentation auditing.
• Strong CPT/HCPCS/ICD-10 knowledge.
• Experience with CMS 1500 and UB04 data elements.
• Experience auditing others and providing feedback.
• MS Office (Excel/Word) proficiency.
• Willingness to travel for testimony.

Responsibilities

• Conduct medical record audits to verify CPT/HCPCS or modifiers align with documentation.
• Handle complex coding reviews and resolve issues for audits and rework.
• Provide written summaries of review findings.
• Articulate findings to investigators, regulators, and leadership.
• Review cases with Medical Directors to validate decisions.
• Research state/CMS guidelines related to audits.
• Mentor new coders and provide training and guidance.
• Identify billing errors, abuse, and fraud; suggest savings opportunities.

Skills

CPC certified

Behavioral Health coding

CPT/HCPCS/ICD-10 knowledge

CMS 1500 / UB04 data elements

Auditing & mentoring

Excel & Word proficiency

Travel willingness

Education

AAPC CPC Certification

GED or High School diploma

Job description

CVS Health is seeking a detail-oriented Medical Coding Auditor to conduct comprehensive reviews of behavioral health records and ensure CPT/HCPCS accuracy. You will audit complex cases, articulate findings to investigators and leadership, and mentor junior coders in a fast-paced environment at our Hartford area location.

Required CPC certification and 3+ years of behavioral health coding or audits; strong knowledge of CPT/HCPCS/ICD-10, CMS 1500/UB04, and MS Office. Travel may be required.