Senior SIU Medical & Behavioral Health Coder

Preferra Insurance; Baton Rouge (LA); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit. The role ensures coding compliance across medical, behavioral health, and related services, with findings communicated to investigators, leadership, and regulators.

Responsibilities include reviewing CPT/HCPCS codes, applying CMS guidelines, and maintaining documentation rigor. Travel may be required; a CPC certification and 3+ years of coding experience are required.

Qualifications

• Must hold AAPC CPC certification with minimum 3 years of medical/behavioral health coding experience.
• Experience with medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, Revenue Codes and CMS 1500/UB04 data elements.

Responsibilities

• Conduct comprehensive medical record reviews to verify coding accuracy against documentation.
• Provide detailed written summaries of findings and articulate results to investigators and stakeholders.
• Identify potential billing errors, abuse, or fraud and assist with research related to coding questions.

Skills

Medical coding knowledge

Attention to detail

Documentation interpretation

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder to perform medical claim reviews for the Special Investigations Unit. The role ensures coding compliance across medical, behavioral health, and related services, with findings communicated to investigators, leadership, and regulators.

Responsibilities include reviewing CPT/HCPCS codes, applying CMS guidelines, and maintaining documentation rigor. Travel may be required; a CPC certification and 3+ years of coding experience are required.