Senior Behavioral Health Coding Auditor & Compliance Lead

CVS Health; Connecticut; Hybrid; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Bonus program eligibility

Job summary

CVS Health is seeking a Senior Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will assess coding accuracy and documentation, ensuring compliance with state, federal, and company policies across medical, behavioral health, and related areas.

The role requires CPC certification, 3+ years of behavioral health coding/auditing, and travel ability.

Qualifications

• AAPC CPC certification required.
• 3+ years of Behavioral Health medical coding or documentation auditing experience.
• Strong knowledge of CPT, HCPCS, ICD-10.
• Familiarity with CMS 1500 and UB04 data elements.
• Experience researching coding and policies.
• Proficiency with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS or modifiers align with documentation.
• Handle complex coding reviews and resolve issues with sensitivity.
• Perform claim reviews for legal, compliance, or rework projects.
• Provide detailed written summaries of review findings.

Skills

Behavioral Health coding

Auditing

Mentoring

Communication with investigators

Education

AAPC CPC Certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Senior Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). You will assess coding accuracy and documentation, ensuring compliance with state, federal, and company policies across medical, behavioral health, and related areas.

The role requires CPC certification, 3+ years of behavioral health coding/auditing, and travel ability.