SIU Medical & Behavioral Health Coding Investigator

Voices for Voices; Hartford (CT); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health seeks a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and compliant documentation. The role requires reviewing CPT/HCPCS codes, applying CMS guidelines, and communicating findings to diverse partners.

Candidates should have 3+ years of medical coding experience, CPC certification, and proficiency with Excel/Word. Travel may be required; full-time hours are 40 per week with robust benefits.

Qualifications

• Minimum of 3 years of experience in medical and/or behavioral health professional coding, with at least 1-2 years of current professional coding experience, including medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Ability to interpret, apply, and consistently apply established coding policies and guidelines.
• Experience with Microsoft Excel and Word.
• Ability to travel for the role, if needed.

Responsibilities

• Conduct a comprehensive medical record review to ensure CPT/HCPCS/Revenue codes and modifiers billed align with documentation.
• Provide detailed written summaries of medical record review findings.
• Articulate findings to investigators, plan leadership, law enforcement, legal counsel, providers, and regulators.
• Apply state or CMS guidelines related to the review with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Identify savings opportunities warranting prepayment review.
• Maintain records and documentation; follow workflows to meet metrics.

Skills

Medical coding

CPT coding

HCPCS coding

Revenue codes

Microsoft Excel

Microsoft Word

Code interpretation

Travel ability

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health seeks a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and compliant documentation. The role requires reviewing CPT/HCPCS codes, applying CMS guidelines, and communicating findings to diverse partners.

Candidates should have 3+ years of medical coding experience, CPC certification, and proficiency with Excel/Word. Travel may be required; full-time hours are 40 per week with robust benefits.