CPC SIU Medical & Behavioral Health Coding Auditor

Voices for Voices; Harrisburg (Dauphin County); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits

Travel opportunities

Bonus eligibility

Job summary

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit. The role ensures accurate coding, documentation, and compliance with state and federal requirements across medical, behavioral health, and related services.

Responsibilities include detailed record reviews, findings communication, and collaboration with Medical Directors. Travel may be required to support investigations and audits; strong analytical and writing skills are

Qualifications

• AAPC CPC certification is required.
• Minimum 3 years of medical/behavioral health coding experience with 1–2 years of current coding and record review.
• Knowledge of CPT, HCPCS, and Revenue Codes; CMS 1500 and UB04 data elements.
• Proficiency in Microsoft Excel and Word.
• Willingness and ability to travel as needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators as needed.
• Apply state or CMS guidelines to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative coding research and policy reviews.
• Identify billing errors, abuse, and fraud, and potential savings opportunities.
• Maintain organized records and documentation consistent with workflows.

Skills

CPC certification

Medical coding (CPT/HCPCS/Rev codes)

Experience: 3+ years

Coding review

MS Excel / Word

Travel ability

Education

AAPC CPC certification

GED or High School 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 accurate coding, documentation, and compliance with state and federal requirements across medical, behavioral health, and related services.

Responsibilities include detailed record reviews, findings communication, and collaboration with Medical Directors. Travel may be required to support investigations and audits; strong analytical and writing skills are