The Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding compliance through comprehensive record review for medical, behavioral, transportation, and other healthcare providers. The role focuses on determining correct coding and appropriate documentation, identifying concerning billing patterns or trends, and supporting investigations related to potential billing errors, abuse, and fraud.
Key responsibilities include conducting detailed medical record audits, preparing written summaries of findings, communicating results to investigators and other stakeholders, researching and applying state and CMS guidelines, reviewing cases with Medical Directors, and maintaining accurate records and documentation. The position also requires staying current on coding compliance and reimbursement changes.
Required qualifications
- AAPC Certified Professional Coder (CPC) certification
- 3+ years of experience in medical coding or documentation auditing
- Knowledge of CPT, HCPCS, ICD-10, CMS 1500, and UB04 data elements
- Experience researching coding and policy guidance
- Proficiency with Microsoft Excel and Word
Preferred qualifications
- CPMA certification
- Prior payor auditing experience
- Strong attention to detail
- Strong communication skills
- Strong analytical skills
- 2+ years of behavioral health coding/auditing experience
Full-time position eligible for a comprehensive benefits package, including:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Bonus, commission, or short-term incentive program eligibility
Location
Georgia, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$43,888 - $93,574
Remote work allowed
No
Posted
1 month ago