SIU CPC Manager - Healthcare Coding & Investigations Lead

CVS Health Corporation; Harrisburg (Dauphin County); On-site; USD 54,000 - 159,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking a CPC Manager to lead the Special Investigations Unit (SIU) medical coding team. You will oversee audits, ensure CPT/HCPCS compliance, and guide complex coding reviews while coordinating with medical directors and regulators.

The role requires AAPC certification, 5+ years in coding/auditing, and strong leadership. Expect a full-time, on-site position with competitive benefits and a pay range reflective of location and experience.

Qualifications

• AAPC Coding certification.
• 5+ years in medical coding or documentation auditing.
• Strong knowledge CPT/HCPCS/ICD-10, CMS 1500, UB04 data elements.
• Keeps coding knowledge up-to-date with changes.
• Experience researching coding and policies.
• Proficient in Excel and Word.
• Strong attention to detail and data interpretation.
• Excellent communication and leadership skills.
• Analytical and able to mentor and develop staff.

Responsibilities

• Lead and mentor a team of CPCs with training and support.
• Audit team performance for CPT/HCPCS and documentation standards.
• Set team goals and monitor performance alignment with goals.
• Direct complex coding reviews and resolve issues, including legal/rework cases.
• Ensure written summaries of findings for investigators, Medicaid leadership, regulators.
• Conduct team performance evaluations and provide feedback.
• Collaborate with Medical Directors to validate decisions on complex cases.
• Manage workload to balance case exposure and development.
• Assist with investigative research on coding questions and policies.
• Identify savings opportunities from potential cases for prepayment review.
• Maintain records and documentation for the team.
• Collaborate with investigators, data analytics, and plan leadership on SIU initiatives.
• Act as primary contact in the director's absence.
• Develop and implement training and onboarding programs.

Skills

AAPC Certification

Medical Coding (CPC)

Experience (5+)

CPT/HCPCS/ICD-10 knowledge

MS Excel/Word

Attention to detail

Communication & Leadership

Mentoring/Team development

Job description

CVS Health is seeking a CPC Manager to lead the Special Investigations Unit (SIU) medical coding team. You will oversee audits, ensure CPT/HCPCS compliance, and guide complex coding reviews while coordinating with medical directors and regulators.

The role requires AAPC certification, 5+ years in coding/auditing, and strong leadership. Expect a full-time, on-site position with competitive benefits and a pay range reflective of location and experience.