CPC: SIU Medical & Behavioral Health Coding Expert

Preferra Insurance; Charleston (WV); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will ensure correct CPT/HCPCS coding, assess record documentation, and identify billing patterns or potential fraud.

Requirements include AAPC CPC, 3+ years of medical coding with record review experience, CMS 1500/UB04 knowledge, Excel, and willingness to travel. This full-time role offers strong benefits, bonus eligibility and a path to contribute to safer

Qualifications

• Must hold AAPC CPC certification and have 3+ years of medical coding experience.
• Experience with medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes; CMS 1500/UB04 data elements.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/modifier accuracy.
• Provide detailed written summaries of findings for investigations.
• Articulate findings to investigators, leadership, regulators, and providers.
• Apply state and CMS guidelines to coding reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, or fraud and suggest savings.

Skills

CPC certification

Medical coding experience

CPT/HCPCS knowledge

CMS 1500 / UB04 knowledge

Excel proficiency

Travel readiness

Documentation auditing

Written and verbal communication

Education

AAPC CPC Certification

GED or High School diploma

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will ensure correct CPT/HCPCS coding, assess record documentation, and identify billing patterns or potential fraud.

Requirements include AAPC CPC, 3+ years of medical coding with record review experience, CMS 1500/UB04 knowledge, Excel, and willingness to travel. This full-time role offers strong benefits, bonus eligibility and a path to contribute to safer