SIU Coding Auditor & Compliance Specialist

ISHE; Northern (KY); 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. You will audit CPT/HCPCS, ICD-10 and UB04 data, ensure documentation aligns with coding guidelines, and communicate findings to investigators and regulators.

The role requires 3+ years of medical coding or documentation auditing, CPC certification, and proficiency with Excel and Word. This is a full-time, on-site position with a strong benefits package.

Qualifications

• AAPC CPC Certification is required.
• Minimum 3 years of medical coding or documentation auditing.
• Knowledge of CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements.
• Experience researching coding and policies.
• Proficiency with Microsoft Excel and Word.

Responsibilities

• Conduct comprehensive medical record audits to ensure coding alignment with documentation.
• Provide detailed written summaries of audit findings.
• Articulate findings to investigators, plan leadership and regulators.
• Apply state or CMS guidelines to audits with minimal support.
• Discuss cases with Medical Directors to validate decisions.
• Identify billing errors, abuse and fraud; pursue savings opportunities.
• Maintain records and follow defined workflows to meet metrics.
• Keep up-to-date coding knowledge with changes in guidelines.

Skills

3+ years of medical coding or auditing

Researching coding and policies

Attention to detail

Communication skills

Auditing experience

Education

AAPC CPC Certification

3+ years experience in medical coding/audit

Tools

Excel

Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. You will audit CPT/HCPCS, ICD-10 and UB04 data, ensure documentation aligns with coding guidelines, and communicate findings to investigators and regulators.

The role requires 3+ years of medical coding or documentation auditing, CPC certification, and proficiency with Excel and Word. This is a full-time, on-site position with a strong benefits package.