CPC SIU Health Coding Investigator

Voices for Voices; Lincoln (NE); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit in Lincoln, NE. The role involves medical claim reviews, ensuring CPT/HCPCS accuracy, and compliant documentation across medical, behavioral health, and related services.

You will summarize findings in writing, discuss cases with Medical Directors, and identify potential billing irregularities. Travel may be required; strong attention to detail and communication are essential.

Qualifications

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

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes and modifiers billed align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, regulators, and providers.
• Research and apply state or CMS guidelines related to the review.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Assist with investigations related to coding questions and policies.
• Maintain records and follow workflows to meet metrics.

Skills

CPC Certification

Medical coding experience

Documentation auditing

Excel

Education

AAPC CPC Certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit in Lincoln, NE. The role involves medical claim reviews, ensuring CPT/HCPCS accuracy, and compliant documentation across medical, behavioral health, and related services.

You will summarize findings in writing, discuss cases with Medical Directors, and identify potential billing irregularities. Travel may be required; strong attention to detail and communication are essential.