SIU Health Coding Analyst (CPC) - Compliance & Fraud

Voices for Voices; Phoenix (AZ); Vor Ort; USD 44.000 - 94.000; Vollzeit

Zusammenfassung

CVS Health in Phoenix, AZ seeks a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and compliant documentation. You will evaluate CPT/HCPCS codes and modifiers against patient records.

Required CPC certification with 3+ years of medical/behavioral health coding experience, including review work. Travel may be needed; full-time role with competitive benefits.

Qualifikationen

• AAPC CPC certification is required.
• Minimum 3 years of medical and/or behavioral health coding experience, with 1–2 years in current coding and record review.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies consistently.
• Proficiency with Microsoft Excel and Word.
• Willingness to travel as needed.

Aufgaben

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes and modifiers align with documentation.
• Provide detailed written summaries of review findings.
• Explain findings to investigators, leadership, and regulators.
• Research CMS/state guidelines related to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with coding questions, policy research, and related investigations.
• Identify potential billing errors, abuse, and fraud; suggest savings opportunities for prepayment review.
• Maintain organized records and documentation; follow established workflows to meet metrics.

Kenntnisse

CPC Certification

Medical Coding

CPT/HCPCS familiarity

Policy interpretation

CMS guidelines

Travel willingness

Microsoft Excel

Microsoft Word

Ausbildung

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Jobbeschreibung

CVS Health in Phoenix, AZ seeks a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and compliant documentation. You will evaluate CPT/HCPCS codes and modifiers against patient records.

Required CPC certification with 3+ years of medical/behavioral health coding experience, including review work. Travel may be needed; full-time role with competitive benefits.