Senior Behavioral Health CPC Auditor – SIU & Compliance

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

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Paid time off

Job summary

CVS Health is seeking a Senior Certified Professional Coder (CPC) for the Special Investigations Unit in Hartford. The role reviews medical records, ensures coding accuracy, and adheres to state and CMS guidelines. You will mentor peers and collaborate with investigators and leadership.

The ideal candidate has 3+ years of behavioral health coding experience, CPC certification, and strong knowledge of CPT/HCPCS/ICD-10. Travel may be required; full-time with benefits.

Qualifications

• CPC certification required.
• 3+ years in behavioral health coding or documentation auditing.
• Strong knowledge CPT/HCPCS/ICD-10 and CMS 1500/UB04 data elements.

Responsibilities

• Conduct comprehensive medical record audits to verify CPT/HCPCS usage.
• Review complex coding cases and assist with investigations.
• Provide written summaries and articulate findings to investigators and leadership.
• Research state and CMS guidelines related to audits and policies.
• Identify potential billing errors, abuse and fraud.

Skills

CPC Certification

Behavioral Health coding

Coding guidelines

Excel

MS Word

Education

AAPC CPC Certification

HS Diploma or GED

Tools

Microsoft Word

Microsoft Excel

Job description

CVS Health is seeking a Senior Certified Professional Coder (CPC) for the Special Investigations Unit in Hartford. The role reviews medical records, ensures coding accuracy, and adheres to state and CMS guidelines. You will mentor peers and collaborate with investigators and leadership.

The ideal candidate has 3+ years of behavioral health coding experience, CPC certification, and strong knowledge of CPT/HCPCS/ICD-10. Travel may be required; full-time with benefits.