CPC SIU Medical & Behavioral Health Coding Auditor

Istss; Frankfort (KY); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Paid time off

Retirement savings

Job summary

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit. The role involves evaluating CPT/HCPCS codes against documentation, communicating findings to investigators, and ensuring compliance with state, federal, and company guidelines.

The candidate should have 3+ years of professional coding experience, CPC certification, and proficiency with CMS 1500/UB04 data elements, with travel as needed.

Qualifications

• AAPC CPC certification and 3+ years of medical/behavioral health coding experience, including record review and auditing.
• Proficiency with CPT, HCPCS, and Revenue Codes; CMS 1500 and UB04 data elements.
• Ability to apply coding policies consistently and to interpret guidelines.

Responsibilities

• Conduct comprehensive medical record reviews to ensure billed codes align with documentation.
• Provide written summaries of review findings and articulate conclusions to investigators and stakeholders.
• Identify billing errors, potential fraud, and opportunities for savings requiring prepayment review when appropriate.
• Maintain organized records and follow established workflows to meet performance metrics.

Skills

Attention to detail

Communication skills

Travel ability

Education

GED or High School diploma

AAPC CPC certification

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit. The role involves evaluating CPT/HCPCS codes against documentation, communicating findings to investigators, and ensuring compliance with state, federal, and company guidelines.

The candidate should have 3+ years of professional coding experience, CPC certification, and proficiency with CMS 1500/UB04 data elements, with travel as needed.