Certified Professional Coder – Special Investigations Unit

• Conduct comprehensive medical record reviews to ensure billing is consistent with medical records
• 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
• 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 prepayment review cases
• Maintain appropriate records, files and documentation
• Travel for meetings and potentially testify

• AAPC Coding certification — Certified Professional Coder (CPC)
• 3+ years of experience in medical coding or documentation auditing
• Strong knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements
• Experience researching coding, state regulations and policies
• Working experience with Microsoft Excel
• Ability to travel for meetings and potential to testify
• GED or equivalent
• AAPC Certified Professional Coder Certification (CPC)

Demonstrates expertise in medical coding and documentation auditing, with a strong focus on compliance with state and federal regulations. Proficient in conducting medical record reviews and articulating findings to various stakeholders.

• AAPC Coding Certification
• Medical Coding Experience
• Knowledge of CPT and HCPCS
• Microsoft Excel Proficiency
• Investigative Research Skills

• Medical Record Review
• Billing Consistency Analysis
• Coding Research
• Billing Error Identification
• Documentation Auditing

• Communication Skills
• Detail Orientation
• Analytical Thinking

• Certified Professional Coder (CPC)

• CPT Codes
• HCPCS Codes
• Revenue Codes
• CMS 1500
• UB04 Data Elements
• State Regulations
• Federal Policies