CPC SIU: Medical & Behavioral Health Code Auditor

Voices for Voices; Columbia (SC); Hybrid; 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). The role requires 3+ years of coding experience, CPT/HCPCS knowledge, and accuracy in medical record documentation review.

Travel for the role may be required and a strong attention to compliance is essential. You will produce detailed findings, articulate conclusions to investigators, and help identify billing errors or fraud while maintaining comprehensive

Qualifications

• Must hold AAPC CPC certification and have 3+ years of medical or behavioral health coding experience.
• Experience with CPT, HCPCS, and Revenue Codes; proficient in CMS 1500/UB04 data elements.
• Ability to interpret and apply coding policies; strong written and verbal communication.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue code accuracy against documentation.
• Provide detailed written summaries of review findings for investigators and leadership.
• Identify potential billing errors, abuse, and fraud and suggest savings opportunities.
• Review cases with Medical Directors to validate decisions and ensure compliance with state/federal guidelines.
• Maintain records and follow workflows to meet performance metrics.

Skills

CPC certification

Medical record review

Documentation auditing

CMS guidelines

Microsoft Excel

Microsoft Word

Travel flexibility

Education

AAPC CPC Certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role requires 3+ years of coding experience, CPT/HCPCS knowledge, and accuracy in medical record documentation review.

Travel for the role may be required and a strong attention to compliance is essential. You will produce detailed findings, articulate conclusions to investigators, and help identify billing errors or fraud while maintaining comprehensive