CPC SIU Manager: Lead Medical Coding & Investigations

CVS Health; Boston (MA); On-site; USD 54,000 - 159,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Paid time off

Job summary

CVS Health seeks a CPC Manager to lead a team of medical coders within the Special Investigations Unit, ensuring accurate coding and documentation during medical record reviews. You will guide staff, conduct audits, and align activities with state, federal, and company policies while detecting potential billing irregularities.

You will mentor CPCs, manage workload distribution, and collaborate with Medical Directors to validate decisions and engage with investigators and regulators as needed.

Qualifications

• AAPC Coding certification required.
• 5+ years of medical coding or documentation auditing experience.
• Strong knowledge of CPT/HCPCS/ICD-10/CMS 1500/UB04 data elements.
• Proficiency in Excel and Word.
• Excellent analytical and leadership skills.

Responsibilities

• Lead and mentor a team of CPCs, providing training and guidance in coding practices and medical record reviews.
• Conduct regular audits to ensure CPT/HCPCS coding and documentation standards are met.
• Set team goals, monitor performance, and align with organizational objectives.
• Oversee complex coding reviews and support investigations, including prepayment reviews when applicable.
• Ensure detailed written summaries of findings and clear articulation to investigators, plan leadership, and regulators.

Skills

Medical coding

Leadership

Analytical skills

Attention to detail

Communications

Education

AAPC Coding certification

Tools

Excel

Word

Job description

CVS Health seeks a CPC Manager to lead a team of medical coders within the Special Investigations Unit, ensuring accurate coding and documentation during medical record reviews. You will guide staff, conduct audits, and align activities with state, federal, and company policies while detecting potential billing irregularities.

You will mentor CPCs, manage workload distribution, and collaborate with Medical Directors to validate decisions and engage with investigators and regulators as needed.