Impactful CPC Auditor - SIU Medical & Behavioral Health

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

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU), ensuring coding accuracy across medical, behavioral health, transportation and other services. The role requires CPC certification, 3+ years coding experience including medical record review, familiarity with CPT/HCPCS/Revenue Codes, and ability to communicate findings to investigators and regulators.

Travel may be required.

Qualifications

• AAPC CPC certification required.
• 3+ years medical/behavioral health coding with at least 1–2 years review experience.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Proficient with Excel and Word.
• Ability to travel for the role.

Responsibilities

• Perform comprehensive medical record reviews to verify codes align with documentation.
• Provide detailed written summaries of review findings.
• Present findings to investigators and stakeholders (e.g., plan leadership, law enforcement, legal counsel, providers, regulators).
• Research CMS guidelines and apply coding policies.
• Identify potential billing errors, abuse, and fraud.
• Maintain records and follow workflows to meet metrics.
• Stay up-to-date with coding changes.

Skills

CPC certification

Medical coding

Audit experience

Communication

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 (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU), ensuring coding accuracy across medical, behavioral health, transportation and other services. The role requires CPC certification, 3+ years coding experience including medical record review, familiarity with CPT/HCPCS/Revenue Codes, and ability to communicate findings to investigators and regulators.

Travel may be required.