Siu Certified Professional Coder (Cpc) (Fully Remote)

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

Pay Range
The typical pay range for this role is:
Minimum: 40,600
Maximum: 83,400

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. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

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. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit

jobs.CVSHealth.com/benefits

Required Qualifications

• Strong attention to detail and ability to review and interpret medical documentation
• Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements.
• Experience preparing written documentation.
• Experience working with Microsoft Excel Spreadsheets.
• Experience with researching coding and policies.
• Behavioral Health medical record coding/auditing experience.
• AAPC Coding certification (CPC) with a minimum of 3+ years of experience in medical coding. CPC is required. CPC-A is not acceptable.
• Ability to travel and participate in legal proceedings, arbitrations, depositions, etc.

Preferred Qualifications

• Licensed Independent Social Worker (LISW)
• Previous work experience with a healthcare insurance company conducting medical record reviews.
• Excellent analytical skills
• Prior auditing experience
• Licensed Clinical Social Worker (LCSW)
• Licensed Master Social Worker (LMSW)
• Excellent communication skills
• Previous Experience with Kentucky Department of Medicaid Services Payment Policies

Education
- Certified Professional Coder - (CPC) through the AAPC.

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.