CVS Health Certified Professional Coder, Special Investigations Unit (SIU) in Dover, Delaware
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.
Position Summary
The Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records.
Responsibilities:
1. Conduct a comprehensive medical record review to ensure billing is consistent with medical record.
2. Provide detailed written summary of medical record review findings.
3. Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.
4. Review and discuss cases with Medical Directors to validate decisions.
5. Assist with investigative research related to coding questions, state and federal policies.
6. Identify potential billing errors, abuse, and fraud.
7. Identify opportunities for savings related to potential cases which may warrant a prepayment review.
8. Ability to travel for meetings and potential to testify.
Required Qualifications
* AAPC Coding certification - Certified Professional Coder (CPC)
* 3+ years of experience in medical coding or documentation auditing.
* Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements.
* Experience with researching coding, state regulations and policies.
* Working experience with Microsoft Excel.
* Strong attention to detail and ability to review and interpret data.
Preferred Qualifications
* 2 years or more previous experience with Behavioral Health coding/auditing of records.
* Licensed Clinical Social Worker (LCSW).
* Licensed Independent Social Worker (LISW).
* Licensed Master Social Worker (LMSW).
* Excellent analytical skills.
Education
* GED or equivalent.
* AAPC Certified Professional Coder Certification (CPC).
Pay Range
The typical pay range for this role is: $43,888.00 - $102,081.60.
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.
We anticipate the application window for this opening will close on: 01/02/2025.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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