CPC-Certified SIU Medical & Behavioral Coder

Preferra Insurance; Frankfort (KY); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Retirement options

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy and proper documentation across medical, behavioral health, and transportation providers.

The CPC will interpret CPT/HCPCS codes, apply CMS/state guidelines, and clearly communicate findings to investigators, leadership, and regulators. Travel may be required; attention to detail is essential.

Qualifications

• Minimum of 3 years of medical/behavioral health coding experience with 1–2 years current coding work.
• Knowledge of CPT, HCPCS, and Revenue Codes; CMS 1500/UB04 data elements.
• Ability to interpret and apply coding policies consistently; strong written and verbal skills.
• Experience with Microsoft Word/Excel and willingness to travel, if needed.

Responsibilities

• Conduct comprehensive medical record reviews to confirm codes match documentation.
• Provide detailed written summaries of findings and discuss cases with investigators.
• Research CMS/state guidelines and apply them to reviews with minimal support.
• Identify billing errors, potential fraud, and opportunities for savings.
• Maintain records and follow workflows to meet performance metrics.

Skills

Medical coding experience

CPT knowledge

HCPCS knowledge

Revenue codes knowledge

Microsoft Excel

Strong communication

Travel willingness

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy and proper documentation across medical, behavioral health, and transportation providers.

The CPC will interpret CPT/HCPCS codes, apply CMS/state guidelines, and clearly communicate findings to investigators, leadership, and regulators. Travel may be required; attention to detail is essential.