CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit (SIU). The role focuses on ensuring compliance with coding practices through comprehensive record review for medical, behavioral, transportation, and other healthcare providers.
The analyst will determine correct coding and appropriate documentation, ensure state, federal, and company requirements are met, and identify billing patterns or trends that may indicate errors, abuse, or fraud. This position also involves preparing written review findings, supporting investigative research, and collaborating with internal leadership, medical directors, law enforcement, legal counsel, providers, and regulators.
Required Qualifications
- AAPC CPC certification
- Minimum 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 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 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
- AAPC Certified Professional Coder (CPC)
- GED or high school diploma
Medical insurance Dental insurance Vision insurance 401(k) Paid maternity leave Paid paternity leave
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$43,888 - $93,574
Remote work allowed
No
Posted
4 weeks ago