CPC SIU: Medical & Behavioral Health Claims Auditor

Preferra Insurance; Bismarck (ND); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit. The role ensures coding compliance with CPT/HCPCS/Revenue codes and reviews documentation in medical records.

Responsibilities include detailed write-ups, communicating findings to investigators and leadership, applying CMS guidelines, and identifying potential billing errors and fraud indicators. Travel may be required.

Qualifications

• Must hold AAPC CPC certification and have 3+ years of medical coding experience including medical record review.
• Experience interpreting CPT/HCPCS/Revenue Codes and CMS 1500/UB04 data elements.
• Strong ability to apply coding policies and communicate findings clearly.
• Proficiency with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue code accuracy.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators and leaders.
• Research state or CMS guidelines relevant to reviews.
• Discuss cases with Medical Directors to validate decisions.
• Identify billing errors, abuse and fraud patterns.
• Maintain records and meet performance metrics.
• Stay current with coding changes and reimbursement rules.

Skills

Attention to detail

Written communication

Verbal communication

Coding resourceful

Education

AAPC CPC certification

GED or HS diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit. The role ensures coding compliance with CPT/HCPCS/Revenue codes and reviews documentation in medical records.

Responsibilities include detailed write-ups, communicating findings to investigators and leadership, applying CMS guidelines, and identifying potential billing errors and fraud indicators. Travel may be required.