CPC-Certified SIU Medical & Behavioral Health Coder

Pennsylvania Psychological Association; Nashville (TN); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews within the Special Investigations Unit. You will ensure coding accuracy, documentation quality, and compliance with state and federal requirements while communicating findings to stakeholders.

The role demands CPC certification, 3+ years in medical/behavioral health coding, and proficiency with CPT/HCPCS, Revenue Codes, CMS 1500/UB04 data, and Microsoft Office. Travel may be required.

Qualifications

• 3+ years of medical and/or behavioral health coding with record review/audit experience.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• Familiarity with CMS 1500 and UB04 data elements.
• Able to interpret and apply coding policies consistently.
• Proficient with 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 findings from reviews.
• Explain findings to investigators, leadership, and regulators as needed.
• Research CMS and state guidelines related to reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with coding and audit-related investigations and fraud detection.
• Identify potential billing errors, abuse, or fraud and potential prepayment savings.
• Maintain organized records and adhere to workflows to meet metrics.

Skills

3+ years medical coding experience

CPT/HCPCS knowledge

Revenue Codes knowledge

CMS 1500 & UB04 data elements

Policy interpretation & application

MS Office Excel & Word

Travel ability

Education

AAPC CPC certification

GED or High School diploma

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews within the Special Investigations Unit. You will ensure coding accuracy, documentation quality, and compliance with state and federal requirements while communicating findings to stakeholders.

The role demands CPC certification, 3+ years in medical/behavioral health coding, and proficiency with CPT/HCPCS, Revenue Codes, CMS 1500/UB04 data, and Microsoft Office. Travel may be required.