Certified Professional Coder, Special Investigations Unit

This is a fully remote position, open to applicants in Alabama, +43 more states.

📋 Description

• Execute medical claim assessments for the Special Investigations Unit (SIU)

• Perform thorough medical record audits to validate CPT/HCPCS codes and modifiers against supporting documentation

• Deliver comprehensive written reports of medical record review outcomes

• Communicate findings effectively to investigators, Medicaid plan leadership, law enforcement, legal representatives, providers, and state regulators

• Investigate and implement state or CMS audit regulations

• Review and confer about cases with Medical Directors

• Support investigative inquiries related to coding inquiries and policies

• Detect potential billing inaccuracies, abuse, and fraud

• Recognize cost-saving opportunities for potential prepayment review cases

• Organize records, files, and documentation meticulously

• Adhere to department workflows and achieve daily performance metrics

• Stay updated with current coding knowledge regarding compliance and reimbursement modifications

⛳️ Requirements

• AAPC Certified Professional Coder Certification (CPC)

• Over 3 years of experience in medical coding or documentation auditing

• Familiarity with CPT, HCPCS, ICD-10, CMS 1500, and UB04 data elements

• Proficiency in researching coding and policies

• Experience using Microsoft applications, particularly Excel and Word

• Exceptional attention to detail and capability to review and interpret data accurately

• Strong verbal and written communication skills

• Previous auditing experience

• Excellent analytical abilities

• A minimum of two years of prior experience in Behavioral Health coding/auditing of records

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Additional resources promoting physical, emotional, and financial well-being

• CVS Health bonus, commission, or short-term incentive program alongside base pay