Senior Behavioral Health Coding Auditor (CPC)

CVS Health; United States; Remote; USD 47,000 - 112,000; Full time

Job summary

CVS Health is seeking a Senior Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring compliance with coding practices and accurate documentation across medical and behavioral health records. The role requires CPC certification, 3+ years in behavioral health coding, proficiency in CPT/HCPCS/ ICD-10, CMS 1500/UB04 data elements, and the ability to travel for testimony.

It offers full-time hours and a comprehensive benefits package.

Qualifications

• 3+ years of Behavioral Health medical coding or documentation auditing.
• Strong knowledge of CPT, HCPCS, and ICD-10 coding guidelines.
• CMS 1500 and UB04 data elements.
• Experience with researching coding and policies.
• Experience mentoring others.
• Must be able to travel to provide testimony if needed.

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS or modifiers billed are consistent with documentation.
• Handles complex coding reviews and will resolve complex issues with sensitivity, including claim reviews for legal, compliance or rework projects.
• Provide detailed written summary of medical record review findings.
• Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.
• Review and discuss cases with Medical Directors to validate decisions.
• Independently research and accurately apply state or CMS guidelines related to the audit.
• Assist with investigative research related to coding questions, state and federal policies.
• Identify potential billing errors, abuse, and fraud.
• Identify opportunities for savings related to potential cases which may warrant a prepayment review.
• Mentor New Coders, providing training, coding, and record review guidance.
• Collaboration with investigators, data analytics and plan leadership on SIU schemes.

Skills

CPC Certification

Behavioral Health coding

CPT/HCPCS/ICD-10 knowledge

Travel readiness

Education

AAPC CPC Certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Senior Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring compliance with coding practices and accurate documentation across medical and behavioral health records. The role requires CPC certification, 3+ years in behavioral health coding, proficiency in CPT/HCPCS/ ICD-10, CMS 1500/UB04 data elements, and the ability to travel for testimony.

It offers full-time hours and a comprehensive benefits package.