Certified Professional Coder, CVS Health

CVS Health

Location:
United States

Category:
-

Contract Type:
Employment contract

Salary:

43888.00 - 102081.00 USD / Year

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Job offer has expired

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 and ensure that state, federal and company requirements are met while recognizing any concerning billing patterns or trends.

Job Responsibility:

Perform medical claim reviews to ensure compliance with coding practices through comprehensive record review
Determine correct coding and appropriate documentation during review of medical records
Ensure state, federal and company requirements are met
Recognize concerning billing patterns or trends
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 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 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

Nice to have:

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)
Prior auditing experience
Excellent analytical skills
Strong attention to detail and ability to review and interpret data
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:
October 30, 2025

Expiration:
October 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Certified Professional Coder