CPC SIU Coding Auditor — Medical & Behavioral Health

Voices for Voices; Atlanta (GA); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in the United States is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and proper documentation across medical, behavioral health, transportation, and other providers.

The role requires CPC certification, 3+ years of professional coding with 1–2 years in record review, CPT/HCPCS knowledge, CMS 1500/UB04 familiarity, Excel proficiency, and travel flexibility.

Qualifications

• AAPC CPC certification required.
• Minimum 3 years of professional coding, including 1–2 years in medical record review.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Proficient with Microsoft Excel.
• Ability to travel, if needed.

Responsibilities

• Review medical records for CPT/HCPCS codes and modifiers.
• Provide written summaries of findings.
• Explain findings to investigators and stakeholders.
• Research CMS guidelines related to the review with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Identify billing errors, abuse and fraud.
• Maintain records and meet metrics.

Skills

CPC certification

Medical coding experience

CPT/HCPCS knowledge

CMS 1500/UB04 data

Excel

Travel availability

Education

AAPC CPC certification (CPC)

GED or High School diploma

Job description

CVS Health in the United States is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and proper documentation across medical, behavioral health, transportation, and other providers.

The role requires CPC certification, 3+ years of professional coding with 1–2 years in record review, CPT/HCPCS knowledge, CMS 1500/UB04 familiarity, Excel proficiency, and travel flexibility.