CPC Coding Auditor - Medical & Behavioral Health SIU

Pennsylvania Psychological Association; City of Albany (NY); Hybrid; 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 for the SIU, ensuring coding accuracy and compliant documentation. You will review CPT/HCPCS codes, compile detailed summaries, and communicate findings to investigators and leadership. Travel may be required.

Requirements include CPC certification, 3+ years of professional coding experience, and proficiency with CMS 1500/UB04 data elements; strong communication skills are essential.

Qualifications

• AAPC CPC certification and 3+ years of medical/behavioral health coding experience.
• Ability to review medical records, apply CPT/HCPCS/revenue codes, and audit documentation.
• Proficiency with CMS 1500 and UB04 data elements; strong written/verbal communication.
• Willingness to travel as needed; familiarity with Microsoft Office applications.

Responsibilities

• Conduct comprehensive medical record reviews to verify coding with documentation.
• Provide detailed written summaries of findings and articulate them to investigators and stakeholders.
• Research CMS guidelines and apply policies; discuss cases with Medical Directors for validation.
• Identify potential billing errors, fraud indicators, and opportunities for savings.
• Maintain records and follow workflows to meet performance metrics.

Skills

CPC certification

Medical coding

Record review

Documentation auditing

MS Excel

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Excel

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation. You will review CPT/HCPCS codes, compile detailed summaries, and communicate findings to investigators and leadership. Travel may be required.

Requirements include CPC certification, 3+ years of professional coding experience, and proficiency with CMS 1500/UB04 data elements; strong communication skills are essential.