CPC Medical Coding Auditor for SIU & Behavioral Health

Istss; Lansing (MI); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

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 SIU, ensuring coding accuracy and compliant documentation across medical, behavioral health, and related services.

The role requires 3+ years of coding experience, CPC certification, CPT/HCPCS knowledge, and the ability to travel if needed. Strong communication and auditing skills are essential for collaboration with investigators and leadership.

Qualifications

• AAPC CPC certification required.
• Minimum 3 years of medical/behavioral health coding experience with 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 and guidelines.
• Experience with Microsoft Excel and Word.
• Willingness to travel, if needed.

Responsibilities

• Perform comprehensive medical record reviews to verify CPT/HCPCS/revenue codes align with documentation.
• Provide detailed written summaries of findings.
• Articulate findings to investigators, leadership, law enforcement, and regulators.
• Research and apply state or CMS guidelines related to reviews.
• Review cases with Medical Directors to validate decisions.
• Assist with coding questions and fraud investigations.
• Identify potential billing errors and savings opportunities.
• Maintain organized records and adhere to workflows.

Skills

CPC certification

Medical coding experience

CPT/HCPCS knowledge

CMS 1500/UB04 knowledge

Microsoft Excel

Microsoft Word

Travel ability

Education

GED or High School diploma

Tools

Excel

Word

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 across medical, behavioral health, and related services.

The role requires 3+ years of coding experience, CPC certification, CPT/HCPCS knowledge, and the ability to travel if needed. Strong communication and auditing skills are essential for collaboration with investigators and leadership.