CPC Certified SIU Medical Coding Auditor

Istss; Columbus (OH); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. You will ensure coding accuracy, review documentation, and identify billing irregularities across medical, behavioral health, and related services.

Travel may be required to collaborate with investigators and regulators. The role requires CPC certification, 3+ years of coding experience, and proficiency with CPT/HCPCS, CMS 1500, and UB04 elements.

Qualifications

• AAPC CPC certification required.
• 3+ years of medical/behavioral health coding experience, including medical record review.
• Ability to interpret and apply CPT, HCPCS, and Revenue Codes; CMS 1500/UB04 data elements.

Responsibilities

• Conduct comprehensive medical record reviews to ensure coding accuracy and documentation alignment.
• Provide detailed written summaries of review findings for investigators and leadership.
• Identify potential billing errors, abuse, and fraud; discuss cases with Medical Directors.

Skills

CPC certification

Medical record review

Coding documentation

Microsoft Excel

Education

CPC certification

GED or High School diploma

Tools

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. You will ensure coding accuracy, review documentation, and identify billing irregularities across medical, behavioral health, and related services.

Travel may be required to collaborate with investigators and regulators. The role requires CPC certification, 3+ years of coding experience, and proficiency with CPT/HCPCS, CMS 1500, and UB04 elements.