CPC-Certified SIU Health Coding Auditor

Istss; Jefferson City (MO); Hybrid; USD 56,000 - 94,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to review medical claims for the SIU, ensuring coding accuracy and compliant documentation. You will interpret CPT, HCPCS, and Revenue Codes, discuss cases with Medical Directors, and help identify potential fraud or billing issues.

Requires AAPC CPC certification, 3+ years coding experience with record review, and willingness to travel. Eligible for a comprehensive benefits package and base pay as shown.

Qualifications

• AAPC CPC certification required.
• Minimum 3 years of medical/behavioral health coding experience, with 1–2 years in medical record review and auditing.
• Knowledge of CPT, HCPCS, Revenue Codes & CMS data elements.
• Proficiency with Microsoft Excel and Word.
• Willingness to travel if needed.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/ Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research state and CMS guidelines related to reviews with minimal support.
• Identify potential billing errors, abuse, and fraud; suggest savings opportunities.

Skills

Medical coding experience

Documentation auditing

Communication skills

Travel flexibility

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to review medical claims for the SIU, ensuring coding accuracy and compliant documentation. You will interpret CPT, HCPCS, and Revenue Codes, discuss cases with Medical Directors, and help identify potential fraud or billing issues.

Requires AAPC CPC certification, 3+ years coding experience with record review, and willingness to travel. Eligible for a comprehensive benefits package and base pay as shown.