CPC Health Coding & SIU Audit Specialist

CVS Health Corporation; Raleigh (NC); On-site; USD 44,000 - 94,000; Full time

Job summary

CVS Health Corporation seeks a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding compliance and accurate documentation. The role requires state, federal, and company guideline adherence, with clear communication to investigators and leadership.

Qualified candidates will have a CPC, 3 years of medical/behavioral health coding experience (including record reviews), and proficiency in CPT/HCPCS/Revenue codes, CMS 1500/UB04 data elements, and Microsoft

Qualifications

• AAPC CPC certification required.
• Minimum of 3 years of medical/behavioral health coding experience with 1–2 years of current coding experience, including medical record review and auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• Familiarity with CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies consistently.
• Proficiency in MS Excel and Word.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue code accuracy against documentation.
• Provide detailed written summaries of findings.
• Explain findings to investigators, leadership, and regulators.
• Research state/CMS guidelines related to reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with coding-related investigative research.
• Identify billing errors, abuse, or fraud and opportunities for savings.
• Maintain records and meet performance metrics.

Skills

CPC certification

Medical coding

CPT/HCPCS/Revenue Codes

Excel

Word

Written/verbal communication

Travel flexibility

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health Corporation seeks a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding compliance and accurate documentation. The role requires state, federal, and company guideline adherence, with clear communication to investigators and leadership.

Qualified candidates will have a CPC, 3 years of medical/behavioral health coding experience (including record reviews), and proficiency in CPT/HCPCS/Revenue codes, CMS 1500/UB04 data elements, and Microsoft