CPC SIU Medical & Behavioral Coding Auditor

Pennsylvania Psychological Association; Columbia (SC); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus program

Comprehensive benefits

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation across medical, behavioral health, and related services.

The CPC will review CPT/HCPCS/Revenue codes, discuss findings with Medical Directors, and help identify potential billing issues while maintaining comprehensive records and supporting investigators as needed.

Qualifications

• Minimum of 3 years of experience in medical and/or behavioral health coding, with 1–2 years in professional coding and record review.
• Must interpret and apply CPT, HCPCS and Revenue Codes consistently.
• Experience with CMS 1500 and UB04 data elements.

Responsibilities

• Conduct comprehensive medical record reviews to verify codes and documentation.
• Provide written summaries of findings and articulate results to investigators and leadership.
• Identify billing errors, potential fraud, and opportunities for savings; maintain records.

Skills

Medical coding knowledge

Medical record review

Documentation auditing

Communication skills

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation across medical, behavioral health, and related services.

The CPC will review CPT/HCPCS/Revenue codes, discuss findings with Medical Directors, and help identify potential billing issues while maintaining comprehensive records and supporting investigators as needed.