This position can be work from home anywhere in the United States.

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. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends.
Activities include:

Conduct a comprehensive medical record review to ensure billing is consistent with medical record.
Provide detailed written summary of medical record review findings.
Meet and discuss findings with providers.
Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.
Review and discuss cases with Medical Directors to validate decisions.
Assist with investigative research related to coding questions, state and federal policies.
Identify potential billing errors, abuse, and fraud.
Identify opportunities for savings related to potential cases which may warrant a prepayment review.
Maintain appropriate records, files, documentation, etc.

Pay Range
The typical pay range for this role is:
Minimum: 40,560
Maximum: 83,400

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

AAPC Coding certification (CPC) or Certified Coding Specialist (CCS) with AHIMA
3+ years of experience in medical CPT/HCPCS coding.
Previous experience with Behavioral Health coding/auditing of records
Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements
Experience with researching coding and policies.
Experience with Microsoft Excel
Ability to travel and participate in legal proceedings, arbitrations, depositions, etc.

Preferred Qualifications

Previous experience coding/auditing behavioral claims
Licensed Clinical Social Worker (LCSW)
Licensed Independent Social Worker (LISW)
Licensed Master Social Worker (LMSW)
Strong attention to detail and ability to review and interpret data
Prior auditing experience
Excellent communication skills
Excellent analytical skills

Education

Certified Professional Coder (AAPC) or other comparable coding certification.

Business Overview
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. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Suggested Searches