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Senior Certified Professional Behavioral Health Coder, Special Investigations Unit
CVS Health. Conduct comprehensive medical record audits to ensure CPT/HCPCS codes and modifiers are consistent with documentation .
Posted 10/22/2026full-timeRemote • Connecticut • United StatesSenior💰 $46,988 - $112,200 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical coding and auditing, particularly in Behavioral Health, with a strong focus on CPT, HCPCS, and ICD-10 guidelines. Capable of conducting thorough audits, mentoring new coders, and articulating findings to various stakeholders while maintaining compliance with state and federal policies.
Highest-signal resume keywords
AAPC Coding Certification - Certified Professional Coder (CPC)3+ Years Experience in Behavioral Health Medical CodingStrong Knowledge of CPT, HCPCS, and ICD-10 Coding GuidelinesExperience Auditing and Providing FeedbackExcellent Communication Skills
ATS Keywords
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Hard Skills
CPT CodingHCPCS CodingICD-10 CodingMedical Record AuditingCoding ComplianceReimbursement ChangesData InterpretationBilling Error IdentificationInvestigative ResearchMentoring
Soft Skills
Attention to DetailAnalytical SkillsCommunication Skills
Tools & Technologies
Microsoft ExcelMicrosoft Word
Certifications & Qualifications
AAPC Coding Certification - Certified Professional Coder (CPC)Licensed Clinical Social Worker (LCSW)Licensed Independent Social Worker (LISW)Licensed Master Social Worker (LMSW)Licensed Professional Counselor (LPC)
Industry Keywords
Behavioral HealthCMS GuidelinesMedicaidLegal ComplianceBilling FraudPrepayment ReviewState RegulatorsMedical DirectorsCPT/HCPCS CodesUB04 Data Elements
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- 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