SIU Medical Claims & Behavioral Health Coder

Voices for Voices; Oklahoma City (OK); 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 compliant documentation. The role involves comprehensive record reviews of CPT/HCPCS codes, communicating findings to investigators and leaders, and applying CMS guidelines with minimal support.

Ideal candidates have 3+ years in professional coding, CPT/HCPCS knowledge, and proficiency with Excel/Word; travel may be required.

Qualifications

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

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/revenue codes match documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Apply state or CMS guidelines to reviews 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 and follow workflows to meet metrics.
• Maintain up-to-date coding knowledge with changes to compliance and reimbursement.

Skills

Attention to detail

Communication skills

Auditing experience

Data interpretation

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation. The role involves comprehensive record reviews of CPT/HCPCS codes, communicating findings to investigators and leaders, and applying CMS guidelines with minimal support.

Ideal candidates have 3+ years in professional coding, CPT/HCPCS knowledge, and proficiency with Excel/Word; travel may be required.