Medical Coding Investigator — SIU (Behavioral Health)

CVS Health; Atlanta (GA); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Retirement savings options

Job summary

CVS Health Corporation is seeking a Certified Professional Coder (CPC) for the SIU to perform medical claim reviews and ensure coding accuracy across CPT/HCPCS and Revenue Codes. The role requires handling complex reviews, detailed reporting, and collaboration with medical directors and regulators.

Qualified candidates will have AAPC CPC certification, 3+ years of coding experience including record reviews, and proficiency with CMS documentation elements.

Qualifications

• AAPC CPC certification and 3+ years of professional coding experience including medical record review and auditing.
• Knowledge of CPT, HCPCS, Revenue Codes and CMS 1500/UB04 data elements.
• Strong written communication and ability to articulate findings to diverse stakeholders.
• Proficiency in Microsoft Word/Excel; ability to work travel as needed.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings to investigators and leadership.
• Articulate findings to investigators, plan leadership, and state regulators.
• Research and apply CMS/state guidelines with minimal supervision.
• Review cases with Medical Directors to validate decisions and collaborate on investigations.
• Identify potential billing errors, abuse or fraud; suggest savings opportunities.
• Document records and follow established workflows to meet metrics.
• Maintain up-to-date coding knowledge and compliance practices.

Skills

CPC coding

Medical record review

Auditing

Excel

Word

Travel

Education

CPC Certification (AAPC)

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health Corporation is seeking a Certified Professional Coder (CPC) for the SIU to perform medical claim reviews and ensure coding accuracy across CPT/HCPCS and Revenue Codes. The role requires handling complex reviews, detailed reporting, and collaboration with medical directors and regulators.

Qualified candidates will have AAPC CPC certification, 3+ years of coding experience including record reviews, and proficiency with CMS documentation elements.