CPC SIU Health Coding Analyst – Investigative Review

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

Job summary

CVS Health Corporation is seeking a CPC-certified medical coder to perform detailed reviews for the Special Investigations Unit. The role focuses on accurate coding and proper documentation across medical and related services, with the ability to communicate findings to investigators and regulators.

Ideal candidates hold CPC certification, have 3+ years of coding experience including record review, and are proficient with CPT/HCPCS, CMS 1500/UB04.

Qualifications

• AAPC CPC certification.
• Minimum of 3 years of medical/behavioral health coding experience, with 1-2 years in current coding and record review.
• Knowledge of CPT, HCPCS, Revenue Codes; CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies and guidelines.
• Proficient with Microsoft Excel and Word; willing to travel.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/modifier accuracy with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, regulators, and providers.
• Apply state or CMS guidelines to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify billing errors, abuse, and fraud; suggest potential savings.
• Maintain records and meet performance metrics.
• Keep up-to-date coding knowledge and reimbursement changes.

Skills

Attention to detail

Communication skills

Analytical thinking

Problem solving

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health Corporation is seeking a CPC-certified medical coder to perform detailed reviews for the Special Investigations Unit. The role focuses on accurate coding and proper documentation across medical and related services, with the ability to communicate findings to investigators and regulators.

Ideal candidates hold CPC certification, have 3+ years of coding experience including record review, and are proficient with CPT/HCPCS, CMS 1500/UB04.