CPC SIU Coding Auditor — Medical & Behavioral Health

CVS Health Corporation; Richmond (VA); On-site; 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 Corporation in Richmond, VA, is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring correct coding and documentation across medical, behavioral health and related services.

The role requires CPC certification, 3+ years coding and record-review experience, proficiency with CPT/HCPCS and CMS 1500/UB04 data elements, MS Excel/Word, and willingness to travel.

Qualifications

• Must have CPC certification and 3+ years coding experience including medical record review and auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• Familiarity with CMS 1500 and UB04 data elements.
• Proficient in MS Excel and Word; able to travel as needed.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/modifier accuracy.
• Provide written summaries of review findings.
• Explain findings to investigators, plan leadership, and regulators as needed.
• Apply state and CMS guidelines to coding reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud; suggest savings opportunities.
• Maintain thorough documentation and follow established workflows.

Skills

Attention to detail

Strong written and verbal comms

Travel willingness

Education

AAPC CPC Certification

GED or High School diploma

Tools

Excel

Word

Microsoft Office

Job description

CVS Health Corporation in Richmond, VA, is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring correct coding and documentation across medical, behavioral health and related services.

The role requires CPC certification, 3+ years coding and record-review experience, proficiency with CPT/HCPCS and CMS 1500/UB04 data elements, MS Excel/Word, and willingness to travel.