Certified Professional Coder, CVS Health

CVS Health

Location:
United States, Remote

Category:
Customer Service

Contract Type:
Employment contract

Salary:

43888.00 - 102081.00 USD / Year

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Job Description:

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.

Job Responsibility:

Perform medical claim reviews to ensure compliance with coding practices
Conduct comprehensive medical record review to ensure billing is consistent with medical record
Provide detailed written summary of medical record review findings
Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators
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
Ability to travel for meetings and potential to testify

Requirements:

AAPC Coding certification - Certified Professional Coder (CPC)
3+ years of experience reviewing and analyzing medical records to determine appropriate CPT and HCPCS code assignments
3+ years' experience of ensuring coding is accurate and compliant with federal regulations, payer policies, and organizational guidelines
Working experience with Microsoft Excel
Strong attention to detail and ability to review and interpret data

Nice to have:

2 years or more previous experience with medical record review within a healthcare insurance company
Prior special investigation unit experience
Excellent analytical skills
Excellent communication skills

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
August 26, 2025

Expiration:
August 29, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Certified Professional Coder