SIU Medical & Behavioral Health CPC Coder

Pennsylvania Psychological Association; Jefferson City (MO); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliance. You will review records, summarize findings, and communicate with investigators and regulators, while adhering to state, CMS, and company guidelines.

Applicants should have a CPC certification, 3+ years of medical/behavioral health coding, proficiency with CPT/HCPCS, CMS 1500/UB04, and strong communication skills. Travel may be required.

Qualifications

• AAPC CPC certification is required.
• 3+ years of medical/behavioral health coding experience, including 1-2 years of current coding and medical record review.
• Knowledge of CPT, HCPCS, and Revenue Codes; CMS 1500 and UB04 data elements.
• Experience with Microsoft Excel and Word.
• Ability to travel for the role, if needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes and modifiers align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research and apply state or CMS guidelines related to the review.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative coding research related to policies.
• Identify potential billing errors, abuse, or fraud.
• Identify savings opportunities that may warrant prepayment review.
• Maintain records and follow workflows to meet metrics.

Skills

Attention to detail

Written and verbal communication

Analytical thinking

Willingness to travel

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliance. You will review records, summarize findings, and communicate with investigators and regulators, while adhering to state, CMS, and company guidelines.

Applicants should have a CPC certification, 3+ years of medical/behavioral health coding, proficiency with CPT/HCPCS, CMS 1500/UB04, and strong communication skills. Travel may be required.