Senior Behavioral Health Coder & Audit Lead

MePA; Hartford (CT); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical, dental & vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a skilled Medical Coding Auditor to ensure accuracy of CPT/HCPCS, ICD-10 and related data in behavioral health audits. You will review cases, discuss findings with Medical Directors, and research CMS guidelines to support investigations.

The role requires CPC certification, 3+ years in behavioral health coding or auditing, and travel readiness. A strong mentoring mindset and proficiency with Excel/Word are essential.

Qualifications

• AAPC CPC certification is required.
• 3+ years in Behavioral Health medical coding or documentation auditing.
• Strong knowledge of CPT, HCPCS, ICD-10 guidelines.
• Experience with CMS 1500 and UB04 data elements.
• Researching coding and policy experience.
• Proficiency with Microsoft Excel and Word.
• Experience auditing others’ work and mentoring others.
• Ability to travel to provide testimony if needed.

Responsibilities

• Conduct comprehensive medical record audits to ensure CPT/HCPCS or modifiers billed align with documentation.
• Handle complex coding reviews and resolve issues with sensitivity for investigations and rework projects.
• Provide written summaries of medical record review findings.
• Articulate findings to investigators, leadership, and regulators.
• Review cases with Medical Directors to validate decisions.
• Apply state or CMS guidelines to audits.
• Support investigations related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud.
• Mentor new coders with training and guidance.
• Collaborate with investigators, data analytics and plan leadership.

Skills

CPC certification

Behavioral Health coding

Auditing

CPT/HCPCS/ICD-10 knowledge

CMS 1500 & UB04

Excel

Word

Mentoring

Travel availability

Education

AAPC CPC Certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a skilled Medical Coding Auditor to ensure accuracy of CPT/HCPCS, ICD-10 and related data in behavioral health audits. You will review cases, discuss findings with Medical Directors, and research CMS guidelines to support investigations.

The role requires CPC certification, 3+ years in behavioral health coding or auditing, and travel readiness. A strong mentoring mindset and proficiency with Excel/Word are essential.