SIU Medical & Behavioral Health Coding Auditor

Preferra Insurance; Montgomery (AL); Hybride; USD 44 000 - 94 000; Plein temps

Avantages offerts par ce poste

Bonus eligibility

Comprehensive benefits

Résumé du poste

CVS Health is seeking a Certified Professional Coder (CPC) to perform comprehensive medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation across medical and behavioral health records. The CPC will interpret CMS and state guidelines, discuss cases with Medical Directors, and identify potential fraud or billing issues.

Required CPC certification and 3+ years of coding experience, with proficiency in CPT/HCPCS, CMS 1500/UB04, and Microsoft Excel.

Qualifications

• AAPC CPC certification required and 3+ years of medical/behavioral health coding experience, including record reviews.
• Proficient in CPT, HCPCS, and Revenue Codes; CMS 1500/UB04 data elements.
• Ability to interpret and apply coding policies with accuracy.
• Proficiency with Microsoft Excel and Word.

Responsabilités

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/revenue code accuracy against documentation.
• Provide detailed written summaries of review findings for investigations and leadership.
• Explain findings to investigators, plan leadership, legal teams, and regulators.
• Research state and CMS guidelines related to reviews with minimal support.
• Collaborate with Medical Directors to validate coding decisions.
• Identify potential billing errors, abuse, and fraud patterns.
• Maintain records and documentation; follow established workflows to meet metrics.

Connaissances

CPC certification

3+ years coding experience

CPT/HCPCS knowledge

CMS 1500/UB04 familiarity

Strong communication skills

Formation

AAPC CPC certification

GED or High School diploma

Outils

Excel

Word

Description du poste

CVS Health is seeking a Certified Professional Coder (CPC) to perform comprehensive medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation across medical and behavioral health records. The CPC will interpret CMS and state guidelines, discuss cases with Medical Directors, and identify potential fraud or billing issues.

Required CPC certification and 3+ years of coding experience, with proficiency in CPT/HCPCS, CMS 1500/UB04, and Microsoft Excel.