SIU Medical & Behavioral Health Coding Specialist
Pennsylvania Psychological Association
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Benefits offered by this job
Job summary
CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The CPC will determine correct coding and documentation during review of medical records and ensure compliance with state, federal, and company guidelines.
Responsibilities include comprehensive record reviews, detailed findings, collaboration with Medical Directors and investigators, researching CMS guidelines, identifying errors and fraud, and maintaining
Qualifications
- AAPC CPC certification.
- weight?:0
Responsibilities
- Conduct comprehensive medical record reviews for coding accuracy.
- Provide detailed written summaries of review findings.
- Articulate findings to investigators, leadership, and regulators.
- Apply state or CMS guidelines with minimal support.
- Review cases with Medical Directors to validate decisions.
- Assist with investigative research related to coding questions and policies.
- Identify billing errors, abuse and fraud.
- Identify savings opportunities for potential cases.
- Maintain records and documentation.
- Follow workflows to meet metrics.
- Maintain up-to-date coding knowledge.
Skills
Education
Tools
Job description
CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The CPC will determine correct coding and documentation during review of medical records and ensure compliance with state, federal, and company guidelines.
Responsibilities include comprehensive record reviews, detailed findings, collaboration with Medical Directors and investigators, researching CMS guidelines, identifying errors and fraud, and maintaining
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