CPC SIU Coding Analyst - Medical & Behavioral Health

CVS Health; Annapolis (MD); On-site; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy across medical, behavioral health and related services.

The role requires 3+ years of professional coding experience, CPC certification, knowledge of CPT/HCPCS and CMS 1500/UB04 elements, and the ability to discuss findings with investigators and leaders; travel may be required.

Qualifications

• AAPC CPC certification and 3+ years coding experience.
• Experience with medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies and guidelines.
• Proficiency with Microsoft Excel and Word.
• Ability to travel for the role, if needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure codes match documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Apply state or CMS guidelines related to reviews.
• Review and discuss cases with Medical Directors to validate decisions.
• Assist with investigative coding research and policy reviews.
• Identify potential billing errors, abuse, and fraud.
• Identify opportunities for savings warranting prepayment review.
• Maintain records and documentation; follow workflows to meet metrics.
• Stay up-to-date with coding changes and reimbursement rules.

Skills

CPC certification

Medical coding

Auditing

Education

AAPC CPC Certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy across medical, behavioral health and related services.

The role requires 3+ years of professional coding experience, CPC certification, knowledge of CPT/HCPCS and CMS 1500/UB04 elements, and the ability to discuss findings with investigators and leaders; travel may be required.