CPC SIU Health Coding Auditor

Istss; Bismarck (ND); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to join the Special Investigations Unit. The role performs medical claim reviews to ensure correct CPT/HCPCS coding and proper documentation across medical, behavioral health, and related services.

You will generate detailed findings, communicate with investigators and regulators, apply CMS guidelines, and help identify billing errors and fraud while maintaining records and meeting performance metrics.

Qualifications

• Must have CPC certification and strong medical coding knowledge.
• Minimum of 3 years of medical or behavioral health coding experience.
• Experience with CPT, HCPCS, Revenue Codes and CMS 1500/UB04.
• Ability to interpret, apply, and consistently apply coding policies and guidelines.
• Willingness to travel for the role as needed.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue codes match documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, regulators, etc.
• Research CMS guidelines related to the review with minimal support.
• Review and discuss cases with Medical Directors to validate decisions.
• Identify billing errors, abuse, and fraud; suggest savings opportunities.
• Maintain records and follow workflows to meet metrics.
• Maintain up-to-date coding knowledge and changes to compliance and reimbursement.

Skills

CPC knowledge

Auditing

Communication

Travel willingness

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to join the Special Investigations Unit. The role performs medical claim reviews to ensure correct CPT/HCPCS coding and proper documentation across medical, behavioral health, and related services.

You will generate detailed findings, communicate with investigators and regulators, apply CMS guidelines, and help identify billing errors and fraud while maintaining records and meeting performance metrics.