Senior SIU Medical Coding & Compliance Analyst

Preferra Insurance; Trenton (NJ); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and compliant documentation across medical, behavioral health, transportation, and other providers.

The role requires CPC certification, 3+ years of coding and record review experience, proficiency with CPT/HCPCS and Revenue Codes, and ability to communicate findings to investigators and regulators.

Qualifications

• AAPC CPC certification required.
• Minimum 3 years in medical/behavioral health coding, including medical record review and auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes.

Responsibilities

• Conduct comprehensive medical record reviews to verify CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators as needed.
• Research and apply CMS/state guidelines related to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigations related to coding questions and policies.
• Identify potential billing errors, abuse, and fraud; flag opportunities for savings.
• Maintain organized records and documentation; follow workflows to meet metrics.

Skills

Strong written and verbal comms

Attention to detail

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit, ensuring coding accuracy and compliant documentation across medical, behavioral health, transportation, and other providers.

The role requires CPC certification, 3+ years of coding and record review experience, proficiency with CPT/HCPCS and Revenue Codes, and ability to communicate findings to investigators and regulators.