CPC SIU Coding Auditor & Fraud Detection Specialist

Voices for Voices; Annapolis (MD); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental & vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to review medical records for coding accuracy and compliance. The role requires CPT/HCPCS expertise, CMS guidelines knowledge, and strong documentation auditing skills.

The position offers full-time hours in Annapolis, MD, with benefits and bonus eligibility. Travel may be required to fulfill investigative duties and collaborate with medical directors and regulators.

Qualifications

• AAPC CPC certification and at least 3 years of medical coding experience.
• Experience with medical record reviews and documentation auditing.
• Familiarity with CPT, HCPCS, Revenue Codes; CMS 1500 and UB04 data elements.
• Proficient with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators as needed.
• Research and apply state or CMS guidelines related to the review with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, or fraud.
• Identify opportunities for savings warranting prepayment review.
• Maintain records and documentation; follow workflows to meet metrics.
• Maintain up-to-date coding knowledge with changes to policies and reimbursement.

Skills

Strong written and verbal comms

CPT/HCPCS/Revenue Codes knowledge

Auditing and record review

Travel for role

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to review medical records for coding accuracy and compliance. The role requires CPT/HCPCS expertise, CMS guidelines knowledge, and strong documentation auditing skills.

The position offers full-time hours in Annapolis, MD, with benefits and bonus eligibility. Travel may be required to fulfill investigative duties and collaborate with medical directors and regulators.