Impactful CPC SIU Medical & Behavioral Health Coder

Istss; Boise (ID); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Bonus eligibility

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform detailed medical record reviews for the Special Investigations Unit. You will ensure CPT/HCPCS/Revenue codes align with documentation and apply state and CMS guidelines with minimal support.

Travel may be required to collaborate with investigators and providers. The role requires 3+ years of professional coding experience (1–2 years in review), CPC certification, and proficiency with CPT, HCPCS, and CMS data elements.

Qualifications

• AAPC CPC certification and 3+ years of medical/behavioral health coding experience, with at least 1–2 years of review work.
• Knowledge of CPT, HCPCS, and Revenue Codes and familiarity with CMS 1500 and UB04 data elements.
• Ability to interpret and apply coding policies consistently.
• Experience with Microsoft Excel and Word.
• Willingness to travel as needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure codes align with documentation.
• Provide detailed written summaries of review findings for investigations.
• Articulate findings to investigators, leadership, and regulators as needed.
• Research state or CMS guidelines related to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with coding questions and policy adherence in investigations.
• Identify potential billing errors, abuse, and fraud.
• Identify savings opportunities that may require prepayment review.
• Maintain thorough records and adhere to workflows to meet metrics.

Skills

CPC certification

Medical coding experience

Documentation auditing

Education

AAPC CPC Certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform detailed medical record reviews for the Special Investigations Unit. You will ensure CPT/HCPCS/Revenue codes align with documentation and apply state and CMS guidelines with minimal support.

Travel may be required to collaborate with investigators and providers. The role requires 3+ years of professional coding experience (1–2 years in review), CPC certification, and proficiency with CPT, HCPCS, and CMS data elements.