Analyst SIU Certified Coder
U.S. Bankruptcy Court - District of CT, Tucson, AZ, United States
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Role Overview
The 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. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records and must also ensure that state, federal and company requirements are met and recognize any concerning billing patterns or trends.
Responsibilities
Conduct a comprehensive medical record audit to ensure the CPT/HCPCS or modifiers billed are consistent with medical record documentation.
Provide detailed written summary of medical record review findings.
Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.
Research and accurately apply state or CMS guidelines related to the audit with minimal support.
Review and discuss cases with Medical Directors to validate decisions.
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, documentation, etc.
Use department resources regularly and follow workflows with minimal assistance or intervention to perform daily work to meet metrics.
Required Qualifications
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
Preferred Qualifications
Strong attention to detail and ability to review and interpret data.
Demonstrates strong communication skills.
Prior auditing experience
Excellent communication skillsExcellent analytical skills
Two years or more previous experience with Behavioral Health coding/auditing of records
Education
Certification in Coding
Compensation
Anticipated Weekly Hours : 40
Time Type : Full time
Pay Range : $43,888.00 - $93,574.00 (This range is the base hourly rate or base annual full‑time salary. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range.)
Benefits
Comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. Includes medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
We anticipate the application window for this opening will close on: 04/30/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Role Overview
The 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. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records and must also ensure that state, federal and company requirements are met and recognize any concerning billing patterns or trends.
Responsibilities
Conduct a comprehensive medical record audit to ensure the CPT/HCPCS or modifiers billed are consistent with medical record documentation.
Provide detailed written summary of medical record review findings.
Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc.
Research and accurately apply state or CMS guidelines related to the audit with minimal support.
Review and discuss cases with Medical Directors to validate decisions.
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, documentation, etc.
Use department resources regularly and follow workflows with minimal assistance or intervention to perform daily work to meet metrics.
Required Qualifications
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
Preferred Qualifications
Strong attention to detail and ability to review and interpret data.
Demonstrates strong communication skills.
Prior auditing experience
Excellent communication skillsExcellent analytical skills
Two years or more previous experience with Behavioral Health coding/auditing of records
Education
Certification in Coding
Compensation
Anticipated Weekly Hours : 40
Time Type : Full time
Pay Range : $43,888.00 - $93,574.00 (This range is the base hourly rate or base annual full‑time salary. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range.)
Benefits
Comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. Includes medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
We anticipate the application window for this opening will close on: 04/30/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr