CPC-SIU Medical & Behavioral Health Auditor

MePA; Annapolis (MD); On-site; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding accuracy. You will review CPT/HCPCS codes, document findings, and communicate results to investigators and regulators.

The role requires 3+ years of coding experience, CPC certification, and proficiency with CPT/HCPCS/Revenue Codes, CMS 1500 and UB04, plus travel as needed. Full-time with comprehensive benefits.

Qualifications

• AAPC CPC certification is required.
• 3+ years of medical/behavioral health coding experience, including record review.
• Knowledge of CPT, HCPCS, Revenue Codes; CMS 1500 and UB04 elements.
• Proficient in Microsoft Excel and Word; ability to travel as needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leaders, and regulators.
• Apply state and CMS guidelines to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse and fraud; suggest savings opportunities.

Skills

Attention to detail

Verbal communication

Written 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 perform medical claim reviews for the Special Investigations Unit (SIU) to ensure coding accuracy. You will review CPT/HCPCS codes, document findings, and communicate results to investigators and regulators.

The role requires 3+ years of coding experience, CPC certification, and proficiency with CPT/HCPCS/Revenue Codes, CMS 1500 and UB04, plus travel as needed. Full-time with comprehensive benefits.