CPC SIU Medical Coding Auditor & Investigator

Voices for Voices; Nashville (TN); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit and ensure coding compliance across medical, behavioral health, transportation, and other healthcare providers.

You will review records for CPT/HCPCS, apply CMS guidelines, and report findings to investigators and leadership. Travel may be required; strong communication and documentation skills are essential.

Qualifications

• AAPC CPC certification required.
• Minimum 3 years of medical and/or behavioral health coding experience.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.

Responsibilities

• Conduct comprehensive medical record reviews to ensure coding accuracy.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, plan leadership, law enforcement, and others.
• Research and apply state or CMS guidelines related to the review.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative research related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Identify opportunities for savings warranting prepayment review.
• Maintain records and documentation; meet metrics.
• Keep up-to-date coding knowledge and compliance.

Skills

CPC certification

Medical coding experience

CPT/HCPCS knowledge

CMS 1500/UB04 knowledge

Microsoft Excel/Word

Travel ability

Education

AAPC CPC Certification

GED or High School diploma

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 and ensure coding compliance across medical, behavioral health, transportation, and other healthcare providers.

You will review records for CPT/HCPCS, apply CMS guidelines, and report findings to investigators and leadership. Travel may be required; strong communication and documentation skills are essential.