CPC-Certified SIU Medical & Behavioral Coding Auditor

Istss; Concord (NH); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to conduct medical claim reviews for the Special Investigations Unit. The role involves ensuring CPT/HCPCS/Revenue code accuracy, preparing detailed summaries, and communicating findings to investigators and leadership.

Travel may be required. Applicants should hold an AAPC CPC certification with 3+ years of medical/behavioral health coding experience, including record review/d documentation auditing, and familiarity with CMS guidelines.

Qualifications

• AAPC CPC certification required.
• Minimum 3 years of medical and/or behavioral health coding experience with 1–2 years of current professional coding experience.
• Knowledge of CPT, HCPCS, Revenue Codes; CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies and guidelines.
• Proficiency with MS Office (Excel, Word).
• Willingness to travel if needed.

Responsibilities

• Perform comprehensive medical record reviews to verify CPT/HCPCS/Revenue code accuracy.
• Provide detailed written summaries of review findings.
• Explain findings to investigators, leadership, and regulators as needed.
• Apply state or CMS guidelines to reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with coding-related investigative research and audits.
• Identify potential billing errors, abuse, and fraud.
• Document and maintain all review records and files.

Skills

CPC Certification

Medical coding

Record review

CMS data elements

MS Excel

Travel flexibility

Education

AAPC CPC Certification

HS diploma or GED

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to conduct medical claim reviews for the Special Investigations Unit. The role involves ensuring CPT/HCPCS/Revenue code accuracy, preparing detailed summaries, and communicating findings to investigators and leadership.

Travel may be required. Applicants should hold an AAPC CPC certification with 3+ years of medical/behavioral health coding experience, including record review/d documentation auditing, and familiarity with CMS guidelines.