Senior CPC Coding Quality Analyst – SIU Investigator

CVSHealth; Minnesota; On-site; USD 47,000 - 102,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Job summary

CVS Health is seeking a Senior Coding Quality Analyst (CPC) to lead medical claim reviews for the SIU, ensuring compliant coding and accurate documentation across medical and behavioral health services.

The role requires CPC certification, 1+ year in quality remediation and coding reviews, and strong CPT/HCPCS/ICD-10 knowledge, with opportunities to mentor staff and improve processes.

Qualifications

• CPC certification required and maintained.
• 1+ year of reviewing coding consultant decisions for quality purposes.
• 1+ year of developing and implementing quality remediation plans.
• 1+ year of experience in medical coding in a Fraud, Waste, Abuse and/or error department.
• Proficient with CPT, HCPCS, ICD-10 coding guidelines.

Responsibilities

• Conduct quality reviews ensuring coding aligns with medical records and CPT/HCPCS/ICD-10 guidelines.
• Analyze data to identify billing errors, abuse, or fraud.
• Prepare detailed written summaries of findings for leadership.
• Research state, CMS, and payer guidelines for audits and reviews.
• Mentor coders on quality standards and review methodology.

Skills

CPC certification

Quality review

Coding accuracy

CPT/HCPCS/ICD-10 knowledge

Policy research

Excel and Word

Education

AAPC CPC certification

GED or high school diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Senior Coding Quality Analyst (CPC) to lead medical claim reviews for the SIU, ensuring compliant coding and accurate documentation across medical and behavioral health services.

The role requires CPC certification, 1+ year in quality remediation and coding reviews, and strong CPT/HCPCS/ICD-10 knowledge, with opportunities to mentor staff and improve processes.