We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality 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 Professional Coder (CPC) will perform 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 healthcare 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. • Provide detailed written summary of medical record review findings. • Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc. • Research and accurately apply state or CMS guidelines related to the audit with minimal support. • 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 cases which may warrant a prepayment review. • Maintain appropriate records, files, documentation, etc. • Uses department resources regularly and follows workflows with minimal assistance or intervention to perform daily work to meet metrics. Required Qualifications • Coding experience within ABA or a Behavioral Health Certification • AAPC Coding certification • 3+ years of experience in medical coding or documentation auditing. • Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10, • CMS 1500 and UB04 data elements • Maintains up-to-date coding knowledge, including new changes to coding compliance and reimbursement. • Experience with researching coding and policies. • Experience with Microsoft products; Excel and Word Preferred Qualifications • Strong attention to detail 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 Certification in Coding Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $43,888.00 - $93,574.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: - Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. - No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. - Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/02/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

SUMMARY: Ensures accurate coding and data quality, creating consistency and efficiency in inpatient and/or outpatient services through ongoing performance of ICD-10-CM and/or CPT coding validation and accurate MS DRG, APR DRG and/or outpatient APC. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Performs coding quality reviews on inpatient records to validate the ICD-10-CM codes, DRG group appropriateness, missed secondary diagnoses and procedures, and ensures compliance with all DRG mandates and reporting requirements. Ensures validity of data prior submission of bill. Performs retrospective coding audits as required. Performs data quality reviews on outpatient encounters to validate the ICD-10-CM, CPT and HPCS Level II codes, modifier assignments, APC group appropriateness, missed secondary diagnosis and procedures and ensure compliance with all outpatient coding mandates. Ensures medical necessity criteria is met and local medical review polices are followed. Continuously evaluates the quality of the clinical documentation to spot incomplete or inconsistent documentation for inpatient encounters that impact code selection and resulting DRG groups and payments. Brings identified concerns to department manager for resolution. Provides training for coding staff and educates facility healthcare professionals in the use of coding guidelines and practices, proper documentation techniques, medical terminology and disease processes as it relates to the MS DRG, APR DRG and/or outpatient APC and other clinical data quality management. Maintains knowledge of current professional coding certification requirements. Reviews LifeChart coding validator, coding error and CED work queues. Identifies any coding or coding related charge issues to leadership. Performs routine coding validation audits. Prepares reports for director on coder accuracy results. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and monitors coding staff for violations and reports to Coding Manager when areas of concern are identified. Provides direction to coding staff in absence of management. MINIMUM QUALIFICATIONS: BASIC KNOWLEDGE: Associate degree in health information technology (preferably with RHIT) and/or successful completion of coding certification program. Understanding of the content of the medical record. Trained in medical terminology, medical science, disease processes anatomy and physiology. Ability to recognize and understand clinical documentation pertinent for coding. Good writing skills to prepare compliant physician queries. Computer literate; capable of researching websites to access regulatory requirements. Ability to navigate the patient electronic medical record. Coding specialist certification required. EXPERIENCE: Five years coding optimization experience in an acute care facility. Past auditing experience or strong training background in coding preferred. WORKING CONDITIONS AND PHYSICAL REQUIREMENTS: After orientation at the hospital’s facilities, work is performed at the employee’s residence in accordance with provisions of a telecommuting work agreement, to which the employee has agreed as a condition of working in an off-campus location. The hospital’s normal office and central work location environment applies for assignments, meetings, and other requirements as determined by department management. INDEPENDENT ACTION: Performs independently within the department’s policies and procedures. Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures are required. SUPERVISORY RESPONSIBILITY: None. Pay Range: $31.00-$51.16 EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. Location: Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903Work Type: Mon-Fri Weekends possible-FlexWork Shift: DayDaily Hours: 8 hoursDriving Required: No

Where You’ll Work From primary to specialty care, as well as walk-in and virtual services, CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours. Job Summary and Responsibilities As a Coder, you will ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently. Every day you will accurately translate patients’ medical records into standardized codes for diagnoses and treatments. Using your expertise and training, you will ensure compliance with legal, regulatory, and organizational standards. To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time. - Accurately abstract information from the medial records into the appropriate coding systems, ensuring compliance with established guidelines. - Determine the most appropriate diagnosis after a thorough review of the medical records. Work closely with practice staff with regards to coding and assignment of a MS-DRGs (Diagnosis Related Group) and APCs (Ambulatory Payment Classification). - Code medical records using ICD-9-CM and CPT-4 coding rules and guidelines. Ensure through and compliant coding to support patient records and submission of billing for payment. - Accurately sequence diagnostic and procedural codes according to organization specified procedures and assigns MSDRG/APC as appropriate. Provide codes various departments upon request. - Enter and validate charges using appropriate tools and validates diagnoses with the medical documentation provided. - Compare charges on accounts with the procedures coded and identifies any discrepancies. Notify Coding Manager of any discrepancies’ and collaborates as needed to rectify the account. Job Requirements Required - Certified Professional Coder, upon hire or - Certified Professional Coder Hospital Apprentice, upon hire or - Certified Professional Coder Apprentice, upon hire or - Certified Coding Associate, upon hire or - Cardiology Coding, upon hire or - Certified Coding Specialist, upon hire or - Certified Coding Specialist - Physician Based, upon hire or - Certified Cardiovascular and Thoracic Surgery Coder, upon hire or - Certified Health Care Compliance, upon hire or - Certified Interventional Radiology Cardio Coder, upon hire or - Certified Professional Coder Hospital, upon hire or - Radiology Certified Coder, upon hire or - Registered Health Information Administrator, upon hire or - Registered Health Information Technician, upon hire Preferred - Prior Healthcare Billing Experience

It's more than a career, it's a calling. MO-REMOTE Worker Type: Regular Job Highlights: Qualifications: Experience with revenue cycle, Epic, and patient accounts Schedule: Full Time. Monday-Friday, 6am - 2:30pm Location: Remote - reside in MO, IL, OK, or WI At SSM Health, we believe in providing our employees with a fulfilling career. We strive to create an environment where individuals can grow both personally and professionally. Our company values diversity, innovation, and collaboration, and we are committed to making a positive impact on the communities we serve. Joining SSM Health means becoming part of a team that is dedicated to providing exceptional patient care and making a difference in people's lives. Our employees are passionate about what they do, and their commitment to our mission is what sets us apart. Remote work: This position may be eligible for remote work in accordance with SSM policies. Note that remote work is not permissible in some states; Human Resources should be consulted for additional information and guidance. *Candidates must reside in MO, IL, OK, or WI Job Summary: Coordinates activities within assigned area in Revenue Cycle. May lead staff in performing activities or tasks. Job Responsibilities and Requirements: PRIMARY RESPONSIBILITIES - Leads or coordinates shift operations of assigned activities, resources, and/or staff. - Serves as a technical or functional resource and performs similar duties with staff in assigned area. - Assigns, monitors and reviews progress of work. Monitors and reports compliance with policies and/or procedures. - Oversees and evaluates orientation and training of assigned staff. May provide input in the review and evaluation of staff performance. - Performs other duties as assigned. EDUCATION - High School diploma/GED or 10 years of work experience EXPERIENCE - Two years’ experience PHYSICAL REQUIREMENTS - Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs. - Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements. - Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors. - Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc. - Frequent keyboard use/data entry. - Occasional bending, stooping, kneeling, squatting, twisting and gripping. - Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs. - Rare climbing. REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS - None Department: 8701090033 HB Billing Work Shift: Day Shift (United States of America) Scheduled Weekly Hours: 40 Benefits: SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs. - Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). - Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday. - Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members. Explore All Benefits SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.