SIU Medical & Behavioral Coding Auditor CPC

CVS Health Corporation; Topeka (KS); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

PTO

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role requires accurate coding and thorough documentation review across medical and behavioral health records, with the ability to present findings to investigators and regulators.

The ideal candidate has 3+ years of coding experience, CPC certification, and strong knowledge of CPT/HCPCS, CMS 1500/UB04.

Qualifications

• AAPC CPC certification required.
• 3+ years in medical/behavioral health coding with record review experience.
• Knowledge CPT, HCPCS, Revenue Codes and CMS 1500/UB04.
• Ability to interpret and apply coding policies consistently.
• Proficiency with Microsoft Excel and Word.
• Willingness to travel as needed.

Responsibilities

• Conduct comprehensive medical record reviews for CPT/HCPCS and modifiers.
• Provide written summaries of findings.
• Articulate findings to investigators and stakeholders.
• Apply state and CMS guidelines to reviews.
• Review cases with Medical Directors to validate decisions.
• Identify billing errors, abuse or fraud.
• Maintain documentation and comply with workflows to meet metrics.

Skills

Medical coding

Record review

Documentation auditing

Excellent communication

Travel flexibility

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 requires accurate coding and thorough documentation review across medical and behavioral health records, with the ability to present findings to investigators and regulators.

The ideal candidate has 3+ years of coding experience, CPC certification, and strong knowledge of CPT/HCPCS, CMS 1500/UB04.