CPC SIU Medical & Behavioral Health Auditor

Pennsylvania Psychological Association; Pierre (SD); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Paid time off

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will ensure CPT/HCPCS/revenue codes and documentation align with medical records and applicable guidelines.

Responsibilities include writing detailed findings, communicating results to investigators and leadership, researching CMS/state guidelines, identifying billing errors or fraud, and maintaining thorough records to support compliant reviews and timely

Qualifications

• CPC certification required.
• 3+ years medical/behavioral health coding experience, incl. record review.
• Ability to interpret coding policies and apply guidelines.
• Experience with CPT, HCPCS, Revenue Codes and CMS data elements.

Responsibilities

• Conduct comprehensive medical record reviews for code accuracy.
• Provide written summaries of review findings.
• Articulate findings to investigators and leadership.
• Research CMS/state guidelines related to reviews.
• Identify potential billing errors, abuse, and fraud.
• Maintain records and meet performance metrics.

Skills

Attention to detail

Written and verbal communication

Travel ability

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). You will ensure CPT/HCPCS/revenue codes and documentation align with medical records and applicable guidelines.

Responsibilities include writing detailed findings, communicating results to investigators and leadership, researching CMS/state guidelines, identifying billing errors or fraud, and maintaining thorough records to support compliant reviews and timely