CPC Medical & Behavioral Health Coding Auditor

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to support the Special Investigations Unit with medical record reviews ensuring correct coding and compliant documentation.

The role requires CPC certification, 3 years of medical/behavioral health coding experience (1–2 years current), CPT/HCPCS and CMS 1500/UB04 knowledge, and travel ability. Competitive benefits and pay range apply.

Qualifications

• AAPC CPC certification.
• 3 years of medical/behavioral health coding experience with at least 1–2 years of current coding work including medical record review.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Proficiency with Microsoft Excel and Word.
• Ability to travel for the role, if needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/modifier accuracy with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators and leadership beyond the organization.
• Apply state or CMS guidelines to reviews 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 potential prepayment reviews.
• Maintain organized records and documentation.
• Follow workflows to meet metrics.

Skills

CPC certification

Medical coding experience

Record review

CPT/HCPCS knowledge

CMS 1500/UB04 data elements

Microsoft Excel

Travel ability

Education

AAPC CPC Certification

GED or High School diploma

Tools

MS Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to support the Special Investigations Unit with medical record reviews ensuring correct coding and compliant documentation.

The role requires CPC certification, 3 years of medical/behavioral health coding experience (1–2 years current), CPT/HCPCS and CMS 1500/UB04 knowledge, and travel ability. Competitive benefits and pay range apply.