Medical Billing and Coding

• 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

Explore Senior Certified Professional Behavioral Health Coder, Special… at CVS Health. Review requirements and application details.

Medical Billing and Coding jobs in Connecticut

Senior Certified Professional Behavioral Health Coder, Special Investigations Unit