CVS Health

Bringing our heart to every moment of your health.

Analyst, SIU Certified Coder

Medical Billing and CodingMedical Billing and CodingFull TimeRemoteTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

Connecticut

Posted

7 days ago

Salary

$43.9K - $93.6K / year

Professional Certificate3 yrs expEnglish

Job Description

• 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

Job 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

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