SIU Coding Lead & Compliance Manager

4004 Aetna Medicaid Administrators; Arizona; Hybrid; USD 54,000 - 159,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health in the United States is seeking a CPC Manager to lead a team of medical coders within the Special Investigations Unit. You will oversee audits, mentor staff, and ensure compliance with CPT/HCPCS, ICD-10, and related documentation standards across medical, behavioral, transportation, and other healthcare services.

With 5+ years in medical coding and an AAPC certification, you will collaborate with Medical Directors and investigators to validate decisions, manage workloads, and drive

Qualifications

• AAPC Coding certification required.
• 5+ years in medical coding or documentation auditing.
• Strong knowledge CPT/HCPCS/ICD-10/CMS 1500/UB04.

Responsibilities

• Lead and mentor a team of CPCs, providing training and guidance in coding practices.
• Conduct regular audits of team performance for CPT/HCPCS coding and documentation standards.
• Establish team goals and monitor performance to align with organizational objectives.
• Direct complex coding reviews and resolve issues with investigators, regulators, and legal counsel.
• Ensure detailed written summaries of medical record review findings for investigators and leadership.
• Collaborate with Medical Directors to validate decisions and discuss complex cases.
• Manage workload distribution to match skills and development needs.
• Identify opportunities for savings and potential prepayment reviews.
• Maintain records and documentation for the team; ensure effective workflows.

Skills

Leadership

CPC Certification

Auditing

Data analysis

Communication

Tools

Excel

Word

Job description

CVS Health in the United States is seeking a CPC Manager to lead a team of medical coders within the Special Investigations Unit. You will oversee audits, mentor staff, and ensure compliance with CPT/HCPCS, ICD-10, and related documentation standards across medical, behavioral, transportation, and other healthcare services.

With 5+ years in medical coding and an AAPC certification, you will collaborate with Medical Directors and investigators to validate decisions, manage workloads, and drive