CPC SIU Coding Auditor – Health Compliance & Investigations

Istss; Nashville (TN); 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 is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy per CPT/HCPCS/Revenue codes, compliant documentation, and adherence to state and CMS guidelines.

The CPC will communicate findings to investigators and leadership while supporting investigations and audits. The position requires 3+ years of professional coding experience, CPC certification, and the ability to travel as needed.

Qualifications

• AAPC CPC certification.
• 3+ years medical/behavioral health coding experience with 1-2 years in medical record review/d documentation auditing.
• Knowledge of CPT, HCPCS and Revenue Codes.
• CMS 1500 and UB04 data elements.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of findings.
• Articulate findings to investigators and leadership.
• Apply CMS/state guidelines to reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with coding-related investigation research.
• Identify potential billing errors, abuse and fraud.
• Maintain records and meet performance metrics.
• Stay updated on coding compliance changes.

Skills

CPC Certification

Medical coding (CPT/HCPCS)

CMS 1500 & UB04

Microsoft Excel

Microsoft Word

Strong communication

Travel flexibility

Education

CPC Certification

GED or HS Diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy per CPT/HCPCS/Revenue codes, compliant documentation, and adherence to state and CMS guidelines.

The CPC will communicate findings to investigators and leadership while supporting investigations and audits. The position requires 3+ years of professional coding experience, CPC certification, and the ability to travel as needed.