# Senior Certified Professional Coder (CPC)

**Company**: CVS Health
**Location**: Work from home, CT
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $46,988.00 - $112,200.00
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/CT---Work-from-home/Senior-Certified-Professional-Behavioral-Health-Coder--Special-Investigations-Unit_R1071466?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_9c91ee82-045

## Description

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

The Senior Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers.

**Responsibilities**

- Conduct comprehensive medical record audits to ensure CPT/HCPCS or modifiers billed are consistent with medical record documentation.

- Handle complex coding reviews and resolve complex issues with sensitivity, including claim reviews for legal, compliance or rework projects.

- Provide detailed written summaries of medical record review findings.

- 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.

- Independently research and accurately apply state or CMS guidelines related to the audit.

- 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, and documentation.

- Mentor new coders, providing training, coding, and record review guidance.

- Collaborate with investigators, data analytics, and plan leadership on SIU schemes.

- Act as management back-up and support the team when the manager is out of the office.

- Maintain up-to-date coding knowledge, including new changes to coding compliance and reimbursement.

**Required Qualifications**

- AAPC Coding certification - Certified Professional Coder (CPC).

- 3+ years of experience in Behavioral Health 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 and policies.

- Experience with Microsoft products, including Excel and Word.

- Prior experience auditing others' work and providing feedback.

- Experience mentoring others.

- Must be able to travel to provide testimony if needed.

**Preferred Qualifications**

- Licensed Clinical Social Worker (LCSW).

- Licensed Independent Social Worker (LISW).

- Licensed Master Social Worker (LMSW).

- Licensed Professional Counselor (LPC).

- Excellent communication skills.

- Excellent analytical skills.

- Strong attention to detail and ability to review and interpret data.

**Benefits** This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

**Anticipated Weekly Hours** 40

**Time Type** Full-time

**Pay Range** $46,988.00 - $112,200.00

## Skills

### Required
- AAPC Coding certification
- CPT
- HCPCS
- ICD-10
- CMS 1500
- UB04
- Microsoft Excel
- Microsoft Word

### Nice to have
- Licensed Clinical Social Worker (LCSW)
- Licensed Independent Social Worker (LISW)
- Licensed Master Social Worker (LMSW)
- Licensed Professional Counselor (LPC)

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/CT---Work-from-home/Senior-Certified-Professional-Behavioral-Health-Coder--Special-Investigations-Unit_R1071466?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)