CPC Specialist - SIU Medical & Behavioral Coding

CVS Health Corporation; Lincoln (NE); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. The CPC will assess CPT/HCPCS/Revenue codes and modifiers against documentation, produce written summaries, and communicate findings to investigators and leaders.

The role requires 3+ years of medical/behavioral health coding experience with current review expertise, plus travel if needed. Full-time, onsite in Lincoln, NE with competitive benefits.

Qualifications

• AAPC CPC certification.
• 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.
• Proficient in Excel and Word; able to travel if needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research CMS/state guidelines related to review with minimal support.
• Review and discuss cases with Medical Directors to validate decisions.
• Identify billing errors, abuse, and fraud.
• Maintain records and meet metrics; follow workflows.
• Keep up-to-date coding knowledge and reimbursement changes.

Skills

CPC certification

Medical coding experience

CPT HCPCS Revenue Codes

CMS 1500 UB04 data elements

Excel

Word

Travel willingness

Education

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health Corporation is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. The CPC will assess CPT/HCPCS/Revenue codes and modifiers against documentation, produce written summaries, and communicate findings to investigators and leaders.

The role requires 3+ years of medical/behavioral health coding experience with current review expertise, plus travel if needed. Full-time, onsite in Lincoln, NE with competitive benefits.