CPC SIU Coding Auditor - Medical & Behavioral Health

Preferra Insurance; Santa Fe (NM); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the SIU, ensuring coding accuracy, documentation alignment, and regulatory compliance. The role involves detailed reports, collaboration with investigators and leadership, and staying current with coding guidelines.

The position expects 3+ years in medical coding with record review experience, CPT/HCPCS knowledge, and the ability to travel as needed.

Qualifications

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

Responsibilities

• Perform 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.
• Research and apply state or CMS guidelines related to reviews.
• Review cases with Medical Directors to validate decisions.
• Assist with coding questions and policy reviews related to investigations.
• Identify potential billing errors, abuse, and fraud.
• Maintain records and meet metrics.
• Maintain up-to-date coding knowledge.

Skills

CPC certification

Medical coding experience

Interpreting coding guidelines

Microsoft Excel

Microsoft Word

Travel willingness

Education

AAPC CPC certification

GED or High School diploma

Tools

CMS 1500 & UB04 data elements

Job description

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the SIU, ensuring coding accuracy, documentation alignment, and regulatory compliance. The role involves detailed reports, collaboration with investigators and leadership, and staying current with coding guidelines.

The position expects 3+ years in medical coding with record review experience, CPT/HCPCS knowledge, and the ability to travel as needed.