SIU Medical & Behavioral Health Coding Auditor

CVS Health Corporation; Austin (TX); Sur place; USD 44 000 - 94 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits package

Bonus eligibility

Résumé du poste

CVS Health Corporation seeks a Certified Professional Coder (CPC) to join the Special Investigations Unit. You will perform medical claim reviews for coding accuracy and compliance across medical, behavioral health, transportation and other services.

You will articulate findings to investigators and leadership, apply CMS guidelines, and identify billing irregularities. This role requires strong attention to documentation, communication skills, and travel as needed.

Qualifications

• AAPC CPC certification and valid credentials
• Minimum of 3 years of experience in medical and/or behavioral health coding
• Knowledge of CPT, HCPCS, and Revenue Codes
• CMS 1500 and UB04 data elements
• Ability to interpret and apply coding policies consistently
• Experience with Microsoft Excel and Word
• Ability to travel for the role, if needed.

Responsabilités

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes and modifiers billed align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, plan leadership, law enforcement, legal counsel, providers and regulators.
• Research CMS/state guidelines related to reviews with minimal support.
• Review and discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud; opportunities for savings.
• Maintain records and follow workflows to meet metrics.
• Maintain up-to-date coding knowledge with changes to coding compliance and reimbursement.

Connaissances

CPC certification

Medical coding

Auditing / record review

Communication with investigators

Travel flexibility

Formation

AAPC Certified Professional Coder Certification (CPC)

GED or High School diploma

Outils

Microsoft Excel

Microsoft Word

Description du poste

CVS Health Corporation seeks a Certified Professional Coder (CPC) to join the Special Investigations Unit. You will perform medical claim reviews for coding accuracy and compliance across medical, behavioral health, transportation and other services.

You will articulate findings to investigators and leadership, apply CMS guidelines, and identify billing irregularities. This role requires strong attention to documentation, communication skills, and travel as needed.