CPC-Certified SIU Medical & Behavioral Health Auditor

Preferra Insurance; Indianapolis (IN); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus program

Benefits package

Job summary

CVS Health is seeking a Certified Professional Coder to join the Special Investigations Unit to review medical records and ensure CPT/HCPCS codes align with documentation. The role includes detailed written summaries and communicating findings to investigators and regulators.

You will apply CMS guidelines, discuss cases with Medical Directors, and identify potential billing issues, fraud, and savings opportunities. Travel may be required.

Qualifications

• AAPC CPC certification and 3+ years of medical coding experience.
• Experience with medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, Revenue Codes and payer guidelines.
• Proficiency with CMS 1500 and UB04 data elements.
• Ability to apply coding policies accurately and consistently.
• Experience using Microsoft Word and Excel; ability to travel.

Responsibilities

• Conduct medical record reviews to verify codes match documentation.
• Provide written summaries of review findings.
• Explain findings to investigators, leadership, and regulators.
• Research CMS guidelines related to the review with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research on coding questions and policies.
• Identify potential billing errors, abuse and fraud.
• Identify savings opportunities for prepayment reviews.
• Maintain proper records and documentation; follow workflows to meet metrics.
• Maintain up-to-date coding knowledge with changes in policy.

Skills

CPC certification

Medical coding

CPT/HCPCS/Revenue codes

CMS 1500/UB04

Excel

Travel

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Excel

MS Word

Job description

CVS Health is seeking a Certified Professional Coder to join the Special Investigations Unit to review medical records and ensure CPT/HCPCS codes align with documentation. The role includes detailed written summaries and communicating findings to investigators and regulators.

You will apply CMS guidelines, discuss cases with Medical Directors, and identify potential billing issues, fraud, and savings opportunities. Travel may be required.