CPC Medical & Behavioral Health Coding Auditor

Voices for Voices; Madison (WI); 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 Special Investigations Unit (SIU). The role ensures coding accuracy, proper documentation, and compliance with state, federal, and company guidelines. Strong communication with investigators and regulators is required.

Qualifications include AAPC CPC certification, 3+ years of coding experience, CPT/HCPCS knowledge, and proficiency with CMS 1500/UB04 data elements. Travel may be needed.

Qualifications

• AAPC CPC certification and 3 years medical/behavioral health coding experience, including reviews.
• Proficiency in CPT, HCPCS, Revenue Codes, CMS 1500/UB04 data elements.
• Proficient in Excel and Word; ability to travel if needed.

Responsibilities

• Conduct comprehensive medical record reviews for accurate coding and documentation.
• Provide detailed written summaries of findings.
• Explain findings to investigators, leadership, and regulators.
• Research and apply state or CMS guidelines to reviews.
• Identify billing errors, abuse, and potential fraud.
• Maintain records and follow defined workflows to meet metrics.
• Stay up-to-date with coding changes.

Skills

CPC certification

Medical coding experience

CPT / HCPCS knowledge

CMS 1500 / UB04 familiarity

MS Excel / Word

Travel availability

Education

GED or High School diploma

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy, proper documentation, and compliance with state, federal, and company guidelines. Strong communication with investigators and regulators is required.

Qualifications include AAPC CPC certification, 3+ years of coding experience, CPT/HCPCS knowledge, and proficiency with CMS 1500/UB04 data elements. Travel may be needed.