Senior SIU Medical & Behavioral Health Coding Auditor
Pennsylvania Psychological Association
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Benefits offered by this job
Job summary
CVS Health is seeking a Certified Professional Coder (CPC) within the Special Investigations Unit to perform medical record reviews and ensure compliant coding across medical, behavioral health, transportation, and related healthcare services. The role requires 3+ years of coding experience with CPT/HCPCS knowledge, CMS 1500/UB04 familiarity, and strong communication, with travel as needed.
This full-time position offers comprehensive benefits and a base pay range with CVS Health bonus
Qualifications
- AAPC CPC certification required.
- Minimum of 3 years of medical and/or behavioral health coding experience, with 1–2 years of current coding experience.
- Knowledge of CPT, HCPCS, and Revenue Codes.
- CMS 1500 and UB04 data elements.
- Proficiency with Microsoft Excel and Word.
- Willingness to travel as needed.
Responsibilities
- Conduct comprehensive medical record reviews to verify CPT/HCPCS codes align with documentation.
- Provide detailed written summaries of review findings.
- Explain results to investigators, plan leadership, and regulators.
- Apply state and CMS guidelines to reviews with minimal support.
- Review cases with Medical Directors to validate decisions.
- Identify potential billing errors, abuse, and fraud.
- Maintain records and documentation; follow workloads to meet metrics.
Skills
Education
Tools
Job description
CVS Health is seeking a Certified Professional Coder (CPC) within the Special Investigations Unit to perform medical record reviews and ensure compliant coding across medical, behavioral health, transportation, and related healthcare services. The role requires 3+ years of coding experience with CPT/HCPCS knowledge, CMS 1500/UB04 familiarity, and strong communication, with travel as needed.
This full-time position offers comprehensive benefits and a base pay range with CVS Health bonus
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