SIU Medical & Behavioral Health Coder & Audit Analyst

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

Job summary

CVS Health Corporation in Concord, NH seeks a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy, compliance, and documentation quality across medical, behavioral health, and related services.

Travel may be required. Qualified candidates have CPC certification, 3+ years of coding and record-review experience, and strong communication skills to present findings to investigators and leadership.

Qualifications

• AAPC CPC certification required.
• Minimum 3 years of medical/behavioral health coding experience, including record review.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• Experience with CMS 1500 and UB04 elements.
• Ability to interpret and apply coding policies consistently.
• Proficiency with Microsoft Word and Excel.
• Ability to travel if needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes and modifiers align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators and stakeholders as needed.
• Apply state or CMS guidelines to reviews with minimal support.
• Review cases with Medical Directors to validate decisions.
• Assist with coding questions and policy research.
• Identify potential billing errors, abuse, and fraud.
• Maintain organized records and documentation.

Skills

CPC certification

Medical coding experience

Medical record review

Documentation auditing

CPT/HCPCS knowledge

CMS 1500/UB04 data elements

Strong communication

Education

AAPC CPC certification

GED or High School diploma

Tools

Excel

Word

Job description

CVS Health Corporation in Concord, NH seeks a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU). The role ensures coding accuracy, compliance, and documentation quality across medical, behavioral health, and related services.

Travel may be required. Qualified candidates have CPC certification, 3+ years of coding and record-review experience, and strong communication skills to present findings to investigators and leadership.