CPC SIU Medical & Behavioral Health Auditor

Preferra Insurance; Concord (NH); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Competitive pay

Job summary

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

Requires AAPC CPC, 3+ years coding experience including record review, CPT/HCPCS/Revenue Codes knowledge, CMS 1500/UB04 data elements, Excel/Word skills, and willingness to travel. Competitive pay and comprehensive benefits.

Qualifications

• AAPC CPC certification required and 3+ years of medical/behavioral health coding experience.
• Experience with medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, Revenue Codes, CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies consistently.
• Willingness to travel when needed and travel-friendly overall.

Responsibilities

• Perform comprehensive medical record reviews to verify coding accuracy against documentation.
• Provide detailed written summaries of review findings for SIU investigations.
• Articulate findings to investigators, leadership, and regulators as needed.
• Apply state/CMS guidelines to coding reviews with minimal supervision.
• Review cases with Medical Directors to validate decisions.
• Identify billing errors, abuse and fraud; assist with related investigations.
• Identify savings opportunities warranting prepayment review.
• Maintain organized records and follow established workflows to meet metrics.
• Stay updated on coding changes and reimbursement guidelines.

Skills

CPC certification

Medical coding

Medical record review

CPT/HCPCS knowledge

Revenue codes knowledge

CMS 1500/UB04 elements

Microsoft Excel/Word

Travel willingness

CPMA certification

CFE/AHFI credentials

Education

AAPC CPC certification

GED or High School diploma

CPMA certification

CFE certification

AHFI accreditation

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 correct coding and compliant documentation across medical, behavioral health, and related services.

Requires AAPC CPC, 3+ years coding experience including record review, CPT/HCPCS/Revenue Codes knowledge, CMS 1500/UB04 data elements, Excel/Word skills, and willingness to travel. Competitive pay and comprehensive benefits.