CPC-Certified SIU Healthcare Coding Analyst (Med/Behavioral)

Voices for Voices; Boise (ID); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. This role ensures coding accuracy across CPT/HCPCS, Revenue Codes and documentation, supporting compliance with state, federal, and company guidelines.

You will analyze records, draft findings, and communicate with investigators and regulators. The position requires 3+ years of coding experience, AAPC CPC certification, proficiency with Excel/Word, and willingness to

Qualifications

• AAPC CPC certification is required.
• 3+ years of medical and/or behavioral health coding experience, including record review and documentation auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Proficiency with Microsoft Excel and Word.
• Ability to travel for the role, if needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure codes/barriers align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, law enforcement, and regulators.
• Apply state or CMS guidelines to reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with investigative coding and policy research.
• Identify potential billing errors, abuse and fraud.
• Identify savings opportunities requiring prepayment review.
• Maintain records and document workflows to meet metrics.
• Keep up-to-date coding knowledge with changes in reimbursement.

Skills

CPC certification

Medical coding experience

CPT/HCPCS knowledge

CMS 1500/UB04 knowledge

Microsoft Excel/Word

Travel willingness

Education

GED or High School diploma

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. This role ensures coding accuracy across CPT/HCPCS, Revenue Codes and documentation, supporting compliance with state, federal, and company guidelines.

You will analyze records, draft findings, and communicate with investigators and regulators. The position requires 3+ years of coding experience, AAPC CPC certification, proficiency with Excel/Word, and willingness to