CPC-Certified SIU Health & Behavioral Coding Auditor

Voices for Voices; Des Moines (IA); Hybrid; USD 56,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits

Paid time off

Retirement options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will determine correct coding and documentation, review records, and ensure compliance with federal, state, and company guidelines.

Travel may be required for the role. The ideal candidate has at least 3 years of coding experience, CPC certification, and proficiency with CPT, HCPCS, Revenue Codes, CMS 1500/UB04, plus strong written and verbal communication

Qualifications

• AAPC CPC certification required.
• Minimum of 3 years of medical and/or behavioral health coding experience, with 1–2 years of current professional coding and record review.
• Knowledge of CPT, HCPCS, Revenue Codes and CMS 1500/UB04 elements.

Responsibilities

• Conduct comprehensive medical record reviews to ensure coding aligns with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research state or CMS guidelines related to the review with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud and document findings.
• Maintain records and follow workflows to meet metrics.

Skills

CPC Certification

Medical coding experience

Record review

Microsoft Excel

Verbal/written communication

Travel ability

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will determine correct coding and documentation, review records, and ensure compliance with federal, state, and company guidelines.

Travel may be required for the role. The ideal candidate has at least 3 years of coding experience, CPC certification, and proficiency with CPT, HCPCS, Revenue Codes, CMS 1500/UB04, plus strong written and verbal communication