Analyst, SIU Certified Coder
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Connecticut • United States
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Salary
💰 $43,888 - $93,574 per year
About the role
- Perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices
- Conduct a comprehensive medical record audit
- Provide detailed written summary of medical record review findings
- Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators
- Research and accurately apply state or CMS guidelines related to the audit
- Review and discuss cases with Medical Directors
- Assist with investigative research related to coding questions
- 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
- Use department resources regularly and follow workflows with minimal assistance or intervention
Requirements
- Coding experience within ABA or a Behavioral Health Certification
- AAPC Coding certification
- 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
- Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement
- Experience with researching coding and policies
- Experience with Microsoft products; Excel and Word
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including 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
- Many other benefits depending on eligibility
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical codingdocumentation auditingcoding complianceCPTHCPCSICD-10CMS 1500UB04billing error identificationinvestigative research
Soft Skills
articulation of findingscommunicationattention to detailanalytical thinkingproblem-solving
Certifications
AAPC Coding certificationBehavioral Health Certification