CPC Senior Medical Coding & SIU Fraud Analyst

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health Corporation seeks a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring CPT/HCPCS accuracy and proper documentation in line with state, CMS, and company guidelines.

Candidates must hold an AAPC CPC and have 3+ years of medical or behavioral health coding experience, including record review, and be able to communicate findings to investigators and leadership. The role is full-time with 40 hours weekly and a comprehensive benefits package.

Qualifications

• AAPC CPC certification
• Minimum 3 years of medical and/or behavioral health professional coding experience
• Knowledge of CPT, HCPCS and Revenue Codes
• CMS 1500 and UB04 data elements
• Ability to interpret and apply coding policies consistently
• Proficiency with Microsoft Excel and Word
• Ability to travel for the role, if needed

Responsibilities

• Conduct comprehensive medical record reviews to ensure codes and modifiers billed align with documentation
• Provide detailed written summaries of review findings
• Articulate findings to investigators and leadership
• Research and apply state or CMS guidelines related to reviews
• Discuss cases with Medical Directors to validate decisions
• Assist with investigative research related to coding questions and policies
• Identify potential billing errors, abuse and fraud
• Identify opportunities for savings warranting prepayment review
• Maintain accurate records and documentation
• Follow workflows to meet performance metrics

Education

AAPC CPC certification

3+ years medical/behavioral health coding experience

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 CPT/HCPCS accuracy and proper documentation in line with state, CMS, and company guidelines.

Candidates must hold an AAPC CPC and have 3+ years of medical or behavioral health coding experience, including record review, and be able to communicate findings to investigators and leadership. The role is full-time with 40 hours weekly and a comprehensive benefits package.