CPC SIU Medical & Behavioral Health Auditor

Voices for Voices; Raleigh (NC); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to review medical records and ensure coding compliance. You will determine correct coding and documentation, aligning with state, federal, and company guidelines.

The role requires comprehensive record reviews of CPT/HCPCS/Revenue codes, documenting findings, and communicating with investigators and regulators. Travel may be required; CPC certification and 3+ years of coding experience are required.

Qualifications

• Strong written and verbal communication skills.
• 3+ years of medical/behavioral health coding with current experience.
• Knowledge of CPT, HCPCS, and Revenue Codes; CMS 1500/UB04 data elements.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue code accuracy.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, plan leadership, and regulators.
• Research state or CMS guidelines related to the review.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative coding questions and policy review.
• Identify potential billing errors, abuse, or fraud and opportunities for savings.
• Maintain records and ensure documentation meets metrics.
• Keep up-to-date coding knowledge with changes in guidelines.

Skills

Communication skills

Education

AAPC CPC certification

Tools

Excel

Word

CMS 1500 & UB04

Job description

CVS Health is seeking a Certified Professional Coder (CPC) for the Special Investigations Unit to review medical records and ensure coding compliance. You will determine correct coding and documentation, aligning with state, federal, and company guidelines.

The role requires comprehensive record reviews of CPT/HCPCS/Revenue codes, documenting findings, and communicating with investigators and regulators. Travel may be required; CPC certification and 3+ years of coding experience are required.