Certified Professional Coder, Special Investigations Unit

This is a fully remote position, open to applicants in Alabama, +42 more states.

📋 Description

• Perform thorough reviews of medical records to ensure billing aligns with documentation.

• Create comprehensive written summaries of findings from medical record reviews.

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

• Collaborate with Medical Directors to review and validate case decisions.

• Support investigative research concerning coding inquiries and state and federal regulations.

• Detect potential billing discrepancies, abuse, and fraudulent activities.

• Identify opportunities for cost savings connected to cases that may require prepayment review.

• Maintain accurate records, files, and documentation.

• Travel for meetings and may be required to provide testimony.

⛳️ Requirements

• AAPC Coding certification — Certified Professional Coder (CPC).

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

• In-depth knowledge of standard industry coding manuals and guidelines, including CPT, HCPCS, Revenue Codes, CMS 1500, and UB04 data elements.

• Experience in researching coding, state regulations, and policies.

• Proficient in Microsoft Excel.

• GED or equivalent education.

• Willingness to travel for meetings and the potential to provide testimony.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.