Talent.com
Oak St. Health
Certified Professional Coder, Special Investigations Unit (Aetna SIU)Oak St. Health • Lansing, MI, United States
No longer accepting applications
Certified Professional Coder, Special Investigations Unit (Aetna SIU)

Certified Professional Coder, Special Investigations Unit (Aetna SIU)

Oak St. Health • Lansing, MI, United States
7 days ago
Salary
$43,888.00–$102,081.00 yearly
Job type
  • Full-time
Job description

Certified Professional Coder (CPC)

We're building a world of health around every individual shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger helping to simplify health care one person, one family and one community at a time.

Position Summary

The Certified Professional Coder (CPC) will perform medical claim reviews 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. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends.

Activities include:

  • Conduct a comprehensive medical record review to ensure billing is consistent with medical record.
  • 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.
  • 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.
  • Ability to travel for meetings and potential to testify

Required Qualifications

- AAPC Coding certification - Certified Professional Coder (CPC)

- 3+ years of experience in medical coding or documentation auditing.

- Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements

- Experience with researching coding, state regulations and policies.

- Working experience with Microsoft Excel

Preferred Qualifications

- 2 years or more previous experience with Behavioral Health coding/auditing of records

- Prior auditing experience

- Excellent analytical skills

- Excellent communication skills

- Strong attention to detail and ability to review and interpret data

Education

- GED or equivalent

- AAPC Certified Professional Coder Certification (CPC)

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $102,081.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full?time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well?being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Create a job alert for this search

Certified Professional Coder, Special Investigations Unit (Aetna SIU) • Lansing, MI, United States

Similar jobs

Remote Consumer Insights Participant

GL IncSt. Johns, Michigan
$15.00 hourly
Remote
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

Software Test Analyst 3

KaavLansing, MI, United States
Full-time

Quality Assurance Analyst with the Department of Technology, Management, and Budget (DTMB) Agency Services supporting the Michigan Department of Transportation (MDOT).The Quality Assurance (QA) Ana... Show more

 • Promoted

Auditor

Capstone LogisticsLansing, MI, United States
Full-time

This role is responsible for auditing the quality of incoming loads, ensuring compliance with established standards, and identifying any deviations.Observe the quality of loads on arrival.Identify ... Show more

 • Promoted

Remote SIU Lead Reviewer

CVS HealthLansing, MI, United States
Remote
Full-time

A leading healthcare solutions company is seeking an analytically driven individual in Lansing, Michigan to join their Special Investigations Unit.This full-time position involves identifying and a... Show more

 • Promoted

Complete Online Surveys For Cash (Up to $25/per)

Earn HausLansing, MI, US
Full-time +1

Looking for people to participate in taking online surveys for Fortune 500 brands.All you need to do is complete online surveys by sharing your opinion.You will help influence brand decisions on se... Show more

 • Promoted

Remote Work – Product Assessments - $25-$45 per hour (No Experience)

Online Consumer Panels AmericaSt. Johns, Michigan, US
$25.00–$45.00 hourly
Remote
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

First Article Inspector - St. Johns Area

The Pivot GroupSaint Johns, MI, United States
Full-time

Partnered by The Pivot Group Network in St. Show more

 • Promoted

Work-From-Home Product Advisor - $45 per hour

Great LionSt. Johns, Michigan
$45.00 hourly
Remote
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

Remote Product Tester - $25-45 per hour

Online Consumer Panels AmericaSt. Johns, Michigan, US
$25.00–$45.00 hourly
Remote
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

Paid Casino Tester

ReeledgeWestphalia, Michigan, United States
$25.00 hourly
Full-time

Join our distributed team and help evaluate online platforms through interactive testing assignments.This is a flexible, remote opportunity with full training provided and no prior experience requi... Show more

 • Promoted

Work From Home Professionals - $45 per hour

GL1St. Johns, Michigan
$45.00 hourly
Remote
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

Treasury - Programmer

KaavDimondale, MI, United States
Full-time

This position will provide maintenance and support for mainframe systems.The position will provide the necessary programming skills using mainframe tools to maintain and support legacy systems.This... Show more

 • Promoted

Work From Home - Product Specialist - $45 per hour

GL1St. Johns, Michigan
$45.00 hourly
Remote
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

Consumer Opinion Research Participant

GL IncSt. Johns, Michigan
$15.00 hourly
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

Data Entry Product Support - No Experience

GLOCPAAlbion, Michigan
$15.00 hourly
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

REMOTE INPATIENT CODER

Sparrow FoundationLansing, MI, United States
Remote
Full-time

Positions Location: Lansing, MI.Advanced coding position that requires review of medical record documentation and accurately assigns ICD-10-CM, ICD-10 PCS, as well as assignment of the Medicare Sev... Show more

 • Promoted

Work-From-Home Product Quality Assurance - $45 per hour

Great LionSt. Johns, Michigan
$45.00 hourly
Remote
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

SIU Investigator - Remote

Michigan StaffingLansing, MI, United States
Remote
Full-time

Siu Investigator - RemoteAt Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve.Looking for a purpose-d... Show more

 • Promoted

Remote Data Entry - Product Support - $45 per hour

GL Inc.St. Johns, Michigan
$45.00 hourly
Remote
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

Data Entry Product Support - $45 per hour - No Experience

GL Inc.St. Johns, Michigan
$45.00 hourly
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more