CPC SIU Medical & Behavioral Health Coding Specialist

Preferra Insurance; Richmond (VA); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus potential

Paid time off

Job summary

CVS Health in Richmond, VA seeks a Certified Professional Coder (CPC) to perform medical record reviews for the Special Investigations Unit, ensuring coding accuracy across CPT/HCPCS, Revenue Codes, and documentation.

The role requires 3+ years of medical coding and auditing experience, CPC certification, strong attention to detail, ability to communicate findings, and willingness to travel.

This full-time role offers a comprehensive benefits package and a competitive pay range.

Qualifications

• AAPC CPC certification required.
• Minimum 3 years medical/behavioral health coding experience, with 1–2 years in current coding and record review.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies consistently.
• Experience with Microsoft Excel and Word.
• Ability to travel for the role.

Responsibilities

• Perform comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes and modifiers align with documentation.
• Provide detailed written summaries of review findings.
• Explain findings to investigators, leadership, and regulators.
• Research and apply state or CMS guidelines to reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Maintain records and documentation; follow workflows to meet metrics.

Skills

CPC certification

Medical coding experience

Record review / auditing

CPT/HCPCS/Revenue Codes knowledge

MS Excel

MS Word

Travel ability

Education

GED or High School diploma

CPC certification

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health in Richmond, VA seeks a Certified Professional Coder (CPC) to perform medical record reviews for the Special Investigations Unit, ensuring coding accuracy across CPT/HCPCS, Revenue Codes, and documentation.

The role requires 3+ years of medical coding and auditing experience, CPC certification, strong attention to detail, ability to communicate findings, and willingness to travel.

This full-time role offers a comprehensive benefits package and a competitive pay range.