[Remote] Certified Professional Coder, Special Investigations Unit (Aetna SIU) at CVS Health

The Certified Professional Coder will perform medical claim reviews to ensure compliance with coding practices through comprehensive record reviews for healthcare providers. Responsibilities include determining correct coding and appropriate documentation, ensuring state, federal, and company requirements are met, and recognizing concerning billing patterns or trends. The role involves conducting medical record reviews, providing detailed written summaries of findings, articulating findings to various stakeholders, reviewing cases with Medical Directors, assisting with investigative research, identifying potential billing errors, abuse, and fraud, identifying opportunities for savings, and maintaining appropriate records. The ability to travel for meetings and potentially testify is also required.