SIU Health Coding Analyst: Compliance & Audit Expert

Pennsylvania Psychological Association; Trenton (NJ); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU), ensuring coding accuracy and documentation alignment across medical, behavioral health, and related services. You will review records, extract findings, and communicate with investigators and regulators.

The role requires CPC certification, 3+ years of medical/behavioral health coding experience, knowledge of CPT/HCPCS/Revenue Codes, CMS 1500/UB04 elements, and

Qualifications

• AAPC CPC certification required.
• Minimum 3 years of experience in medical/behavioral health coding, with 1-2 years current professional coding experience, including medical record review and documentation auditing.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Demonstrated ability to interpret, apply, and consistently apply established coding policies and guidelines.
• Experience with Microsoft Excel and Word.
• Ability to travel for the role, if needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, planners, law enforcement, and regulators.
• Research and apply state or CMS guidelines with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative coding questions and regulatory policies.
• Identify potential billing errors, abuse, and fraud.
• Identify opportunities for savings warranting prepayment review.
• Maintain records and documentation following workflows to meet metrics.
• Maintain up-to-date coding knowledge with changes in policy and reimbursement.

Skills

CPC certification

Medical coding

Medical record review

Policy interpretation

Microsoft Excel

Microsoft Word

Travel flexibility

Education

AAPC Certified Professional Coder Certification (CPC)

GED or High School diploma

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU), ensuring coding accuracy and documentation alignment across medical, behavioral health, and related services. You will review records, extract findings, and communicate with investigators and regulators.

The role requires CPC certification, 3+ years of medical/behavioral health coding experience, knowledge of CPT/HCPCS/Revenue Codes, CMS 1500/UB04 elements, and