CPC SIU Medical & Behavioral Health Coder & Auditor

Preferra Insurance; Jefferson City (MO); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Retirement savings options

Paid time off

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) for its Special Investigations Unit (SIU) to review medical records and ensure coding compliance across CPT, HCPCS and Revenue Codes. You will generate detailed findings, discuss cases with Medical Directors, and ensure adherence to state, federal, and company guidelines.

Travel may be required. The role requires 3+ years of professional coding experience, CPC certification, and proficiency with CMS 1500/UB04 data elements, with strong

Qualifications

• Must hold AAPC CPC certification and have 3+ years of medical or behavioral health coding experience including record review and auditing.
• Proficient with CPT, HCPCS, and Revenue Codes; CMS 1500/UB04 data elements.
• Able to interpret and apply coding policies consistently across reviews.
• Strong communication skills to articulate findings to various stakeholders.
• Willingness to travel as needed for the role.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Apply state or CMS guidelines to reviews with minimal guidance.
• Review cases with Medical Directors to validate decisions.
• Assist with investigations related to coding questions and policies.
• Identify potential billing errors, abuse, or fraud.
• Maintain organized records and meet daily workload metrics.
• Keep up-to-date coding knowledge with changes in compliance and reimbursement.

Skills

CPC certification

Medical coding experience

Record review/audit

CMS guidelines knowledge

Education

AAPC CPC certification

GED or High School diploma

CPMA certification

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) for its Special Investigations Unit (SIU) to review medical records and ensure coding compliance across CPT, HCPCS and Revenue Codes. You will generate detailed findings, discuss cases with Medical Directors, and ensure adherence to state, federal, and company guidelines.

Travel may be required. The role requires 3+ years of professional coding experience, CPC certification, and proficiency with CMS 1500/UB04 data elements, with strong