CPC SIU Coding & Compliance Analyst

CVS Health Corporation; Bismarck (ND); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus program

Comprehensive benefits

Paid time off

Retirement plan

Job summary

CVS Health Corporation seeks a Certified Professional Coder (CPC) to join the Special Investigations Unit. The role centers on medical claim reviews, coding accuracy, and detecting billing irregularities across medical, behavioral health, and related services.

You will review CPT/HCPCS/Revenue codes, prepare detailed summaries, and articulate findings to investigators and leadership. Travel may be required, with a strong emphasis on compliance and documentation auditing.

Qualifications

• AAPC CPC certification required.
• 3+ years of medical or behavioral health coding experience, with 1–2 years in professional coding and records review.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements familiarity.
• Ability to interpret and apply coding policies consistently.
• Proficient in Microsoft Excel and Word.

Responsibilities

• Perform comprehensive medical record reviews for coding accuracy.
• Provide written summaries of findings.
• Explain findings to investigators and leadership.
• Apply CMS guidelines to reviews with minimal support.
• Collaborate with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Maintain records and meet performance metrics.
• Stay current with coding changes.

Skills

CPC certification

Medical coding experience

CPT/HCPCS knowledge

CMS 1500 & UB04 knowledge

Excel & Word skills

Travel ability

Education

AAPC CPC Certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health Corporation seeks a Certified Professional Coder (CPC) to join the Special Investigations Unit. The role centers on medical claim reviews, coding accuracy, and detecting billing irregularities across medical, behavioral health, and related services.

You will review CPT/HCPCS/Revenue codes, prepare detailed summaries, and articulate findings to investigators and leadership. Travel may be required, with a strong emphasis on compliance and documentation auditing.