Senior Certified Professional Behavioral Health Coder, Special Investigations Unit

Job not on LinkedIn

🔥 0 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $47k - $112.2k / year

⏰ Full Time

🟠 Senior

🏥 Medical Billing and Coding

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Conduct comprehensive medical record audits to ensure CPT/HCPCS codes and modifiers are consistent with documentation • Handle complex coding reviews, including legal, compliance, and rework projects • Provide detailed written summaries of medical record review findings • Articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state regulators • Review and discuss cases with Medical Directors to validate decisions • Research and accurately apply state or CMS guidelines related to audits • Assist with investigative research on coding questions, state and federal policies • Identify potential billing errors, abuse, and fraud • Identify savings opportunities for cases that may warrant prepayment review • Maintain records, files, and documentation • Follow department workflows and meet daily work metrics independently • Mentor new coders and provide training, coding, and record review guidance • Collaborate with investigators, data analytics, and plan leadership on SIU schemes • Act as management backup when the manager is out of the office • Maintain up-to-date coding knowledge, including coding compliance and reimbursement changes

🎯 Requirements

• AAPC Coding certification — Certified Professional Coder (CPC) • 3+ years of experience in Behavioral Health medical coding or documentation auditing • Strong knowledge of CPT, HCPCS, and ICD-10 coding guides and guidelines • Knowledge of CMS 1500 and UB04 data elements • Experience researching coding and policies • Experience with Microsoft products, including Excel and Word • Prior experience auditing others' work and providing feedback • Experience mentoring others • Ability to travel to provide testimony if needed • GED or High School diploma • Preferred: Licensed Clinical Social Worker (LCSW), Licensed Independent Social Worker (LISW), Licensed Master Social Worker (LMSW), or Licensed Professional Counselor (LPC) • Preferred: Excellent communication skills • Preferred: Excellent analytical skills • Preferred: Strong attention to detail and ability to review and interpret data

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay