SIU CPC Manager: Lead Medical Coding & Investigations

CVS Health Corporation; Phoenix (AZ); Presencial; USD 54.000 - 159.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical

Dental

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources, based on eligibility

Descripción de la vacante

CVS Health Corporation is hiring a Certified Professional Coder (CPC) Manager to oversee a team of medical coders within the Special Investigations Unit (SIU). You will lead audits, ensure CPT/HCPCS accuracy, and maintain high standards for documentation and regulatory compliance.

You will train and mentor staff, coordinate with Medical Directors, and manage workload to support investigators and regulators while driving process improvements and cost savings.

Formación

• AAPC Coding certification.
• 5+ years of experience in medical coding or documentation auditing.
• Strong knowledge of CPT, HCPCS, ICD-10, CMS 1500, and UB04 data elements.
• Maintains up-to-date coding knowledge including new changes to coding compliance and reimbursement.
• Experience researching coding and policies.
• Proficiency in Microsoft products, particularly Excel and Word.
• Strong attention to detail and ability to review and interpret data.
• Demonstrates strong communication and leadership skills.

Responsabilidades

• Lead and mentor a team of CPCs, providing training and guidance in coding practices and medical record reviews.
• Conduct regular audits of team performance to ensure CPT/HCPCS coding and documentation standards.
• Establish team goals, monitor performance, and align with organizational objectives.
• Direct and oversee complex coding reviews and resolve issues with sensitivity, including claim reviews for legal, compliance, or rework projects.
• Ensure staff provide detailed written summaries of medical record review findings and articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and regulators.
• Conducts team member evaluations and provides ongoing feedback.
• Collaborate with Medical Directors to validate decisions and discuss complex cases.
• Manage workload to ensure equitable distribution and exposure to a wide range of cases.
• Assist with investigative research related to coding questions and state/federal policies.

Conocimientos

Leadership

Auditing

Medical coding

CPT/HCPCS coding

Communication

Herramientas

Microsoft Excel

Microsoft Word

Descripción del empleo

CVS Health Corporation is hiring a Certified Professional Coder (CPC) Manager to oversee a team of medical coders within the Special Investigations Unit (SIU). You will lead audits, ensure CPT/HCPCS accuracy, and maintain high standards for documentation and regulatory compliance.

You will train and mentor staff, coordinate with Medical Directors, and manage workload to support investigators and regulators while driving process improvements and cost savings.