CPC SIU Health Coding Auditor & Fraud Insight

Pennsylvania Psychological Association; Annapolis (MD); On-site; USD 44,000 - 94,000; Full time

Job summary

CVS Health is hiring a Certified Professional Coder (CPC) for its Special Investigations Unit. You will review medical records, ensure codes and documentation align, and prepare detailed summaries.

You will communicate findings to investigators, plan leadership, and regulators as required. The role requires CPC certification, 3+ years of coding experience (including record review), and proficiency with CPT/HCPCS/Revenue codes.

Qualifications

• AAPC CPC certification is required.
• 3+ years of medical/behavioral health coding experience, including medical record review.
• Knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 elements.
• Ability to interpret and apply coding policies consistently.
• Proficient with Microsoft Excel and Word.
• Willingness to travel as needed.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue codes match documentation.
• Provide detailed written summaries of review findings.
• Explain findings to investigators and leadership as needed.
• Research and apply CMS/state guidelines to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with coding and audit-related investigations as needed.
• Identify billing errors, abuse, and potential fraud; note savings opportunities.
• Maintain proper records and documentation; follow workflows to meet metrics.
• Stay up-to-date with coding changes and reimbursement rules.

Skills

Attention to detail

Communication

Flexibility to travel

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is hiring a Certified Professional Coder (CPC) for its Special Investigations Unit. You will review medical records, ensure codes and documentation align, and prepare detailed summaries.

You will communicate findings to investigators, plan leadership, and regulators as required. The role requires CPC certification, 3+ years of coding experience (including record review), and proficiency with CPT/HCPCS/Revenue codes.