CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit (SIU). This role focuses on ensuring compliance with coding practices through comprehensive record review for medical, behavioral, transportation, and other healthcare providers.
The analyst will review records to confirm that CPT, HCPCS, revenue codes, and modifiers billed are consistent with documentation, identify potential billing errors and fraud, and support investigative and compliance efforts. The role also requires the ability to communicate findings clearly to investigators, leadership, legal counsel, providers, and regulators.
Required qualifications
- AAPC CPC certification
- Minimum of 3 years of experience in medical and/or behavioral health professional coding
- At least 1-2 years of current professional coding experience, including medical record review and documentation auditing
- Knowledge of professional coding systems including CPT, HCPCS, and revenue codes
- Understanding of CMS 1500 and UB04 data elements
- Ability to interpret and consistently apply coding policies and guidelines
- Experience with Microsoft products, including Excel and Word
- Ability to travel if needed
Preferred qualifications
- CPMA certification
- CFE certification or AHFI accreditation
- Experience with coding and audit functions in a health plan or payer environment
- Strong attention to detail
- Strong written and verbal communication skills
Education
- High school diploma or GED
Compensation
- Annual pay range: $43,888 to $93,574
- Eligible for bonus, commission, or short-term incentive program
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Additional colleague support resources
Location
Alabama, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$43,888 - $93,574
Remote work allowed
No
Posted
1 month ago