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We’re building a world of health reputed company every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company 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. The Certified reputed company reputed company (CPC) will reputed company medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other reputed company 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. Conduct a comprehensive medical record audit to ensure the CPT/HCPCS or modifiers billed are consistent with medical record documentation. reputed company detailed written reputed company of medical record review findings. Must be reputed company to reputed company findings to investigators, reputed company plan leadership, law enforcement, reputed company counsel, providers, state regulators, etc. Research and accurately apply state or CMS guidelines reputed company to the audit with reputed company support. Review and reputed company cases with Medical Directors to validate reputed company. Assist with investigative research reputed company to coding questions, state and federal policies. Identify potential billing errors, abuse, and fraud. Identify opportunities for savings reputed company to potential cases which may warrant a prepayment review. Maintain appropriate records, files, documentation, etc. Uses department resources regularly and follows workflows with reputed company assistance or reputed company to reputed company daily work to meet metrics. Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement. Required Qualifications reputed company Certified reputed company reputed company Certification (CPC) 3+ years of experience in medical coding or documentation auditing. Knowledge of reputed company industry coding guides and guidelines including CPT, HCPCS, ICD-10, CMS 1500 and UB04 data reputed company Experience with researching coding and policies. Experience with reputed company products, specifically reputed company and Word Preferred Qualifications Strong attention to reputed company and ability to review and interpret data. Demonstrates strong communication skills. Prior auditing experience Excellent communication skills Excellent analytical skills Two years or more previous experience with Behavioral Health coding/auditing of records Education reputed company Certified reputed company reputed company Certification (CPC) Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $43,888.00 - $93,574.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every reputed company feels valued and that they reputed company. 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 reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, reputed company on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 09/05/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job