Senior Behavioral Health Coding Auditor & Compliance Lead

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

Benefits offered by this job

Bonus eligible

Comprehensive benefits

Paid time off

Job summary

CVS Health in Hartford, CT is seeking a Senior Certified Professional Coder (CPC) to conduct medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation across medical, behavioral health, and related services.

The role requires CPC certification, 3+ years in behavioral health coding or audits, knowledge of CPT/HCPCS/ICD-10, and the ability to communicate findings to investigators and leadership.

Qualifications

• AAPC CPC certification is required for the role.
• 3+ years of Behavioral Health medical coding or documentation auditing.
• Strong knowledge of CPT, HCPCS and ICD-10 coding guidelines.
• Experience with CMS 1500 and UB04 data elements.
• Proficient in Excel and Word; able to research coding policies.
• Experience auditing others' work and mentoring others.
• Willingness to travel to provide testimony if needed.

Responsibilities

• Conduct comprehensive medical record audits to ensure billed codes match documentation.
• Handle complex coding reviews and resolve issues for investigations or rework.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, plan leadership, and regulators.
• Review cases with Medical Directors to validate decisions.
• Research and apply state or CMS guidelines for audits.
• Identify potential billing errors, abuse and fraud; suggest savings.
• Mentor new coders and provide guidance on coding and record review.

Skills

CPC Certification

CPC Coding

CPT/HCPCS/ICD-10 knowledge

Excel

Word

Mentoring

Travel readiness

Education

CPC Certification

GED or High School diploma

Tools

CMS 1500 & UB04 data elements

Job description

CVS Health in Hartford, CT is seeking a Senior Certified Professional Coder (CPC) to conduct medical claim reviews for the SIU, ensuring coding accuracy and compliant documentation across medical, behavioral health, and related services.

The role requires CPC certification, 3+ years in behavioral health coding or audits, knowledge of CPT/HCPCS/ICD-10, and the ability to communicate findings to investigators and leadership.