CPC SIU Coding Auditor — Medical & Behavioral Health

Voices for Voices; Pierre (SD); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews in the Special Investigations Unit. The role requires CPC certification, 3+ years of coding experience, and strong attention to documentation accuracy.

The CPC must determine correct coding, ensure compliance with state, federal and company requirements, and recognize billing patterns or trends during reviews.

Qualifications

• AAPC CPC certification is required.
• Minimum of 3 years of medical/behavioral health coding experience with record review.
• Knowledge of CPT, HCPCS, and Revenue Codes and CMS 1500/UB04 elements.
• Strong ability to interpret and apply coding policies consistently.
• Proficient in Microsoft Excel and Word; ability to travel as needed.

Responsibilities

• Conduct comprehensive medical record reviews for coding accuracy.
• Provide detailed written summaries of findings.
• Articulate findings to investigators and leadership.
• Apply state/CMS guidelines to reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Identify billing errors, abuse, and fraud; assist with investigations.
• Maintain records and follow workflows to meet metrics.
• Keep coding knowledge up to date with changes.

Skills

CPC coding

Medical record review

Policy interpretation

Excellent communication

Travel ability

Education

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews in the Special Investigations Unit. The role requires CPC certification, 3+ years of coding experience, and strong attention to documentation accuracy.

The CPC must determine correct coding, ensure compliance with state, federal and company requirements, and recognize billing patterns or trends during reviews.