Elite SIU Medical Coding & Compliance Analyst

Istss; Lincoln (NE); Hybrid; 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 is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). This role ensures coding accuracy, maintains documentation, and communicates findings to investigators and regulators.

The position requires CPT/HCPCS expertise, CMS 1500/UB04 knowledge, and readiness to travel as needed. The incumbent will conduct comprehensive record reviews, provide detailed summaries, and stay current with coding changes.

Qualifications

• Must hold AAPC CPC certification.
• Minimum 3 years of medical/behavioral health coding experience, with at least 1–2 years of current professional coding experience.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• Familiar with CMS 1500 and UB04 data elements.
• Proficient in Microsoft Excel and Word.
• Ability to travel for the role, if 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.
• Apply state or CMS guidelines to reviews with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Identify savings opportunities for prepayment review.Maintain records and documentation.

Skills

CPC certification

Medical coding

CPT/HCPCS knowledge

CMS 1500/UB04 data

Excel/Word

Travel ability

Auditing/record review

Education

GED or HS diploma

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). This role ensures coding accuracy, maintains documentation, and communicates findings to investigators and regulators.

The position requires CPT/HCPCS expertise, CMS 1500/UB04 knowledge, and readiness to travel as needed. The incumbent will conduct comprehensive record reviews, provide detailed summaries, and stay current with coding changes.