SIU Coding Analyst: Medical & Behavioral Health Auditor

Preferra Insurance; Columbia (SC); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, vision

Bonus program

Paid time off

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy, proper documentation, and compliance with state and federal requirements.

You will review CPT/HCPCS data, discuss findings with Medical Directors, and identify potential fraud indicators. The position requires AAPC CPC certification and 3+ years of coding experience, including record review.

Qualifications

• Must hold AAPC CPC certification.
• Minimum 3 years medical/behavioral health coding experience, with 1-2 years review/audit experience.
• Knowledge of CPT, HCPCS, Revenue Codes.

Responsibilities

• Conduct comprehensive medical record reviews to ensure codes match documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators and leadership as needed.
• Research state or CMS guidelines for reviews.
• Review cases with Medical Directors to validate decisions.
• Identify potential billing errors, abuse, and fraud.
• Maintain records and documentation.

Skills

Coding knowledge

Attention to detail

Written & verbal comms

Travel ability

Auditing experience

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy, proper documentation, and compliance with state and federal requirements.

You will review CPT/HCPCS data, discuss findings with Medical Directors, and identify potential fraud indicators. The position requires AAPC CPC certification and 3+ years of coding experience, including record review.