SIU Medical Coding Auditor & Investigator

Preferra Insurance; Austin (TX); Hybride; USD 44 000 - 94 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Résumé du poste

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. The CPC ensures coding accuracy, validates documentation, and applies CMS guidelines during record reviews.

The role requires 3+ years in medical/behavioral health coding with 1–2 years in current practice, proficiency with CPT/HCPCS/Revenue Codes, CMS 1500/UB04 data elements, and strong communication for investigations and reporting.

Qualifications

• 3 years of medical and/or behavioral health professional coding experience, with 1–2 years in current professional coding including medical record review.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• Experience with CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies and guidelines.
• Experience with Microsoft Excel and Word.

Responsabilités

• Perform comprehensive medical record reviews ensuring CPT/HCPCS/Revenue codes align with 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.
• Discuss cases with Medical Directors to validate decisions.
• Assist with coding questions and policy research.
• Identify potential billing errors, abuse or fraud.
• Identify savings opportunities warranting prepayment reviews.
• Maintain records and documentation.
• Follow workflows to meet metrics.

Connaissances

Medical coding

Record review

Auditing

Communication

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 medical claim reviews for the Special Investigations Unit. The CPC ensures coding accuracy, validates documentation, and applies CMS guidelines during record reviews.

The role requires 3+ years in medical/behavioral health coding with 1–2 years in current practice, proficiency with CPT/HCPCS/Revenue Codes, CMS 1500/UB04 data elements, and strong communication for investigations and reporting.