CPC SIU Coding & Audit Analyst

Preferra Insurance; Jackson (MS); Hybrid; 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 and compliant documentation. The role requires strong knowledge of CPT/HCPCS and revenue codes, with the ability to discuss findings with investigators and regulators.

Responsibilities include comprehensive record reviews, detailed summaries, and applying CMS guidelines. Travel may be required; MS Excel/Word proficiency is essential, and a CPC certification is

Qualifications

• AAPC CPC certification and 3+ years of medical/behavioral health coding experience.
• Experience with CPT, HCPCS, Revenue Codes, CMS 1500/UB04 data elements.
• Ability to interpret and apply coding policies; travel as needed.
• Proficient with MS Excel and Word; strong documentation skills.

Responsibilities

• Conduct comprehensive medical record reviews to verify codes match documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Apply state and CMS guidelines to coding reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Identify billing errors, potential fraud, and opportunities for savings.
• Maintain records and follow workflows to meet metrics.

Skills

CPC coding

Medical record review

Documentation auditing

Travel flexibility

Education

CPC certification

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. The role requires strong knowledge of CPT/HCPCS and revenue codes, with the ability to discuss findings with investigators and regulators.

Responsibilities include comprehensive record reviews, detailed summaries, and applying CMS guidelines. Travel may be required; MS Excel/Word proficiency is essential, and a CPC certification is