Certified Professional Coder, Special Investigations Unit (Aetna SIU)

DaMar Staffing; Sacramento (CA); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews ensuring coding compliance across medical, behavioral, transportation and other healthcare contexts. The CPC reviews records to determine correct coding and documentation while meeting state, federal and company requirements and spotting concerning billing patterns.

Responsibilities include conducting full medical record reviews, providing detailed findings, communicating with investigators and

Qualifications

• AAPC CPC certification required.
• 3+ years in medical coding or documentation auditing.
• Strong knowledge of CPT/HCPCS/Revenue Codes and CMS 1500/UB04.
• Experience researching coding, state regulations and policies.
• Proficient with Microsoft Excel.

Responsibilities

• Conduct comprehensive medical record reviews to ensure billing aligns with the record.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, regulators, and stakeholders.
• Discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Travel for meetings and potential testimony.

Skills

Medical coding

Auditing experience

Excel proficiency

Communication skills

Education

GED or equivalent

AAPC CPC Certification

Tools

Microsoft Excel

Job description

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.

Position Summary

The Certified Professional Coder (CPC) will perform medical claim reviews 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.

Activities include:

• Conduct a comprehensive medical record review to ensure billing is consistent with medical record.
• 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.
• 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.
• Ability to travel for meetings and potential to testify

Required Qualifications

• AAPC Coding certification - Certified Professional Coder (CPC)
• 3+ years of experience in medical coding or documentation auditing.
• Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements
• Experience with researching coding, state regulations and policies.
• Working experience with Microsoft Excel

Preferred Qualifications

• 2 years or more previous experience with Behavioral Health coding/auditing of records
• Prior auditing experience
• Excellent analytical skills
• Excellent communication skills
• Strong attention to detail and ability to review and interpret data

Education

• GED or equivalent
• AAPC Certified Professional Coder Certification (CPC)

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $102,081.00

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 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 well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 10/17/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.