235 cpc siu coding auditor jobs found

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to review medical records for coding accuracy and compliance. The role requires CPT/HCPCS expertise, CMS guidelines knowledge, and strong documentation auditing skills. The position offers full-time hours in Annapolis, MD, with benefits and bonus eligibility. Travel may be required to fulfill investigative duties and collaborate with medical directors and regulators. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews in the Special Investigations Unit. The role requires CPC certification, 3+ years of coding experience, and strong attention to documentation accuracy. The CPC must determine correct coding, ensure compliance with state, federal and company requirements, and recognize billing patterns or trends during reviews. #J-18808-Ljbffr

CVS Health in the United States is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and proper documentation across medical, behavioral health, transportation, and other providers. The role requires CPC certification, 3+ years of professional coding with 1–2 years in record review, CPT/HCPCS knowledge, CMS 1500/UB04 familiarity, Excel proficiency, and travel flexibility. #J-18808-Ljbffr

CVS Health Corporation in Richmond, VA, is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring correct coding and documentation across medical, behavioral health and related services. The role requires CPC certification, 3+ years coding and record-review experience, proficiency with CPT/HCPCS and CMS 1500/UB04 data elements, MS Excel/Word, and willingness to travel. #J-18808-Ljbffr

CVS Health seeks a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding compliance. You will review medical records for CPT/HCPCS and Revenue codes, document findings, and communicate findings to investigators, leadership, and regulators. Travel may be required to support cases and audits. Required CPC certification with 3+ years of coding experience, including record review, and proficiency in CPT/HCPCS, CMS 1500, and #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to join the Special Investigations Unit. The role performs medical claim reviews to ensure correct CPT/HCPCS coding and proper documentation across medical, behavioral health, and related services. You will generate detailed findings, communicate with investigators and regulators, apply CMS guidelines, and help identify billing errors and fraud while maintaining records and meeting performance metrics. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to review medical claims within the Special Investigations Unit. You will ensure coding consistency, review documentation, and identify irregular billing patterns. The role requires CPC certification, at least 3 years of medical/behavioral health coding experience, and ability to travel if needed. Full-time position with comprehensive benefits and merit-based incentive opportunities. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation across medical, behavioral health, and related services. The CPC will review CPT/HCPCS/Revenue codes, discuss findings with Medical Directors, and help identify potential billing issues while maintaining comprehensive records and supporting investigators as needed. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation. You will review CPT/HCPCS codes, compile detailed summaries, and communicate findings to investigators and leadership. Travel may be required. Requirements include CPC certification, 3+ years of professional coding experience, and proficiency with CMS 1500/UB04 data elements; strong communication skills are essential. #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role requires accurate coding and thorough documentation review across medical and behavioral health records, with the ability to present findings to investigators and regulators. The ideal candidate has 3+ years of coding experience, CPC certification, and strong knowledge of CPT/HCPCS, CMS 1500/UB04. #J-18808-Ljbffr

CVS Health Corporation in Baton Rouge, LA is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) and ensure coding practices align with medical record documentation. Required: at least 3 years of medical/behavioral health coding, CPC certification, CPT/HCPCS knowledge, CMS 1500/UB04 experience, and strong written/verbal communication. This full-time role offers a comprehensive benefits package, travel as needed, and potential #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and proper documentation in medical records. The role requires knowledge of CPT/HCPCS, CMS guidelines, and ability to communicate findings to investigators and leadership. Travel may be required. Ideal candidates hold CPC certification and 3+ years of coding experience, including record review and auditing, with proficiency in Excel/Word and a commitment to accuracy #J-18808-Ljbffr

CVS Health is seeking a Certified Professional Coder (CPC) to conduct medical claim reviews for the Special Investigations Unit. The role involves ensuring CPT/HCPCS/Revenue code accuracy, preparing detailed summaries, and communicating findings to investigators and leadership. Travel may be required. Applicants should hold an AAPC CPC certification with 3+ years of medical/behavioral health coding experience, including record review/d documentation auditing, and familiarity with CMS guidelines. #J-18808-Ljbffr

Description: Investigates complex healthcare claims flagged by third-party referrals, tips, or external allegations prior to payment. This role combines advanced clinical coding expertise (ICD-10, CPT, HCPCS) with investigative scrutiny. The auditor reviews medical records to verify that documented services match the billed codes, adhere to medical necessity guidelines, and comply with state, federal, and contractual coding regulations. Key responsibilities: Allegation Triaging & Investigation: Analyze incoming third-party referrals, compliance tips, and external fraud allegations to identify specific billing patterns, suspect providers, or unbundled services. Identify potential fraud, waste, abuse, billing irregularities, and patterns of non-compliance through medical record review and claims analysis. Pre-Payment Clinical Review: Perform comprehensive clinical and technical reviews of high-dollar or highly complex medical records before a claim is finalized for...

This is fully remote in any state except NY, CA, HI or AK Pre-Payment Clinical Auditor (RN/Coder) Investigates complex healthcare claims flagged by third-party referrals, tips, or external allegations prior to payment. This role combines advanced clinical coding expertise (ICD-10, CPT, HCPCS) with investigative scrutiny. The auditor reviews medical records to verify that documented services match the billed codes, adhere to medical necessity guidelines, and comply with state, federal, and contractual coding regulations. Key responsibilities: Allegation Triaging & Investigation: Analyze incoming third-party referrals, compliance tips, and external fraud allegations to identify specific billing patterns, suspect providers, or unbundled services. Identify potential fraud, waste, abuse, billing irregularities, and patterns of non-compliance through medical record review and claims analysis. Pre-Payment Clinical Review: Perform comprehensive clinical and technical...

Overview About us: Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region....

SIU ICD10 Professional Coder - Healthcare Fraud, Waste and Abuse Department - Hybrid 2 days in office SIU ICD10 Professional Coder - Healthcare Fraud, Waste and Abuse Department - Hybrid 2 days in office Location US-MA-Worcester Job ID 8406 # Positions 1 Category Professionals Location US-MA-Worcester Job ID 8406 # Positions 1 Category Professionals Overview About us: Fallon Health is a company that cares. We prioritize our members-always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability,...

Medical Compliance AuditorWe are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria.Think you've got what it takes?Job Duties & ResponsibilitiesAssess the treatment plan, clinical information, and medical necessity of all requested servicesUtilizes established criteria to appropriately review billed services within established timeframe required.Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate.Refers case...

Coding Auditor Department: SIU Employment Type: Full Time Location: Headquarters Description The Coding Auditor is a professional auditing role designed for a certified professional coder. Under direct supervision of Healthcare Fraud Shield SIU management, this position executes routine coding reviews to ensure health records align accurately with billed ICD-10-CM, CPT, HCPCS, Revenue codes. The ideal candidate has a strong foundation in primary medical coding and a keen eye for detail, eager to learn complex audit frameworks, regulatory policies, and documentation validation. Key Responsibilities Compare the procedures and codes billed on a claim to a medical record. Compare information submitted on the claims in order to determine amount and nature of billable services as needed. Determines appropriateness of billing and reimbursement as needed. Documents findings for each claim line in a spreadsheet as needed. Summarize findings in a written report as needed. Abstracts...

Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its...

Overview The Professional Coding Compliance Specialist provides revenue cycle support to Riverside Medical Group and its coding team by regularly auditing provider documentation and corresponding coding to ensure correct, complete and compliant practices that fully support diagnoses reported and charges submitted for services rendered, meet regulatory and payor-specific requirements, and accurately describe the patient encounter; providing feedback and education to providers and coders based on audit results, regulatory changes, and industry trends; assisting with orientation of new providers, residents/fellows, and new members of the coding team. Essential Duties Completes timely audits of assigned providers and coders for accurate, complete, and compliant ICD-10-CM and CPT/HCPCS code assignment, ensuring that documentation supports the diagnoses reported, E/M level selected, and CPT/HCPCS codes submitted for services rendered during the episodes of care reviewed Reviews...

Department: 10407 Enterprise Revenue Cycle - Coding Production Operations: Inpatient Coding Operations Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Will support : A mix of inpatient community and academic coding. Includes service lines such as cardiology, neurology, and oncology. Schedule : Full-time, Monday-Friday 40hrs with a standard schedule of Monday through Friday, 8 hours per day, totaling 40 hours each week. Certification required : Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA). Remote opportunity: Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY Pay Range: $33.05 - $49.60 Major...

Department: 10407 Enterprise Revenue Cycle - Coding Production Operations: Inpatient Coding Operations Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Will support : A mix of inpatient community and academic coding. Includes service lines such as cardiology, neurology, and oncology. Schedule : Full-time, Monday-Friday 40hrs with a standard schedule of Monday through Friday, 8 hours per day, totaling 40 hours each week. Certification required : Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA). Remote opportunity: Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY Pay Range: $33.05 - $49.60 Major...

Department: 10407 Enterprise Revenue Cycle - Coding Production Operations: Inpatient Coding Operations Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Will support : A mix of inpatient community and academic coding. Includes service lines such as cardiology, neurology, and oncology. Schedule : Full-time, Monday-Friday 40hrs with a standard schedule of Monday through Friday, 8 hours per day, totaling 40 hours each week. Certification required : Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA). Remote opportunity: Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY Pay Range: $33.05 - $49.60...